MEDICARE: CITIZENS CHOICE HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1770172843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITIZENS CHOICE HOME CARE LLC

Provider Business Mailing Address
First Line	:	111 E CHARLOTTE AVE STE J
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-2274
Country	:	US
Telephone Number	:	704-246-6180
Fax Number	:	704-246-6089

Provider Business Practice Location Address
First Line	:	111 E CHARLOTTE AVE STE J
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-2274
Country	:	US
Telephone Number	:	704-246-6180
Fax Number	:	704-246-6089

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BRITTONEY T GIBSON
Credential	:
Telephone Number	:	704-246-6180

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	03/21/2026

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