Healthcare Provider Details

I. General information

NPI: 1326653890
Provider Name (Legal Business Name): CHOSEN CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 FOREST SPRINGS DR
ATLANTA GA
30338-3506
US

IV. Provider business mailing address

144 CLEMENS AVE
NEW BRAUNFELS TX
78130-5613
US

V. Phone/Fax

Practice location:
  • Phone: 772-341-6847
  • Fax:
Mailing address:
  • Phone: 830-455-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: ANGELA WHITE
Title or Position: COO
Credential:
Phone: 830-455-0101