MEDICARE: SELF-DIRECTED CHOICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093150328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELF-DIRECTED CHOICES, LLC

Provider Business Mailing Address
First Line	:	3909 JUAN TABO BLVD NE
Second Line	:	SUITE 2
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3992
Country	:	US
Telephone Number	:	505-508-1663
Fax Number	:	888-541-7076

Provider Business Practice Location Address
First Line	:	3909 JUAN TABO BLVD NE
Second Line	:	SUITE 2
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3992
Country	:	US
Telephone Number	:	505-508-1663
Fax Number	:	888-541-7076

Authorized Official
Title or Position	:	OWNER/EXECUTIVE DIRECTOR
Name	:	MS. SANDRA M SKAAR
Credential	:	MSW
Telephone Number	:	505-508-1663

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	04/30/2013

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Directions to “SELF-DIRECTED CHOICES, LLC ” Practice Location

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