MEDICARE: YOUR CHOICE SERVICES INC

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	251C00000X	Developmentally Disabled Services Day Training Agency	MHL092673	NC

General Provider Information

NPI Number	:	1659497154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR CHOICE SERVICES INC

Provider Business Mailing Address
First Line	:	3824 BARRETT DR
Second Line	:	SUITE 105
City	:	RALEIGH
State	:	NC
Zip	:	27609-7220
Country	:	US
Telephone Number	:	919-889-0012
Fax Number	:	919-786-4948

Provider Business Practice Location Address
First Line	:	3824 BARRETT DR
Second Line	:	SUITE 105
City	:	RALEIGH
State	:	NC
Zip	:	27609-7220
Country	:	US
Telephone Number	:	919-889-0012
Fax Number	:	919-786-4948

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JOHN WILLIAM GIBSON SR.
Credential	:
Telephone Number	:	919-889-0012

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	06/18/2013

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