MEDICARE: CHOICE PAIN & REHABILITATION CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1871135947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE PAIN & REHABILITATION CENTER LLC

Provider Business Mailing Address
First Line	:	9133 OLD ANNAPOLIS RD
Second Line	:	SUITE 203-204
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1970
Country	:	US
Telephone Number	:	410-505-8605
Fax Number	:

Provider Business Practice Location Address
First Line	:	9123 OLD ANNAPOLIS RD STE 203
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1970
Country	:	US
Telephone Number	:	410-505-8605
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TRISTAN J SHOCKLEY
Credential	:	MD
Telephone Number	:	410-505-8605

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	06/15/2026

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