Provider Demographics
NPI:1962103176
Name:LIFE'S INTENTION BACK TO BASICS INC.
Entity type:Organization
Organization Name:LIFE'S INTENTION BACK TO BASICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRIGAL-BATES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCA, CADC II, QMHP
Authorized Official - Phone:541-969-1941
Mailing Address - Street 1:920 SW FRAZER AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2802
Mailing Address - Country:US
Mailing Address - Phone:541-969-1941
Mailing Address - Fax:541-429-4941
Practice Address - Street 1:920 SW FRAZER AVE STE 212
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2802
Practice Address - Country:US
Practice Address - Phone:541-969-1941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No251B00000XAgenciesCase Management
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility