Healthcare Provider Details

I. General information

NPI: 1164906111
Provider Name (Legal Business Name): CHOICES TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2018
Last Update Date: 09/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 PONTIAC DR
AURORA IL
60502-8806
US

IV. Provider business mailing address

2823 PONTIAC DR
AURORA IL
60502-8806
US

V. Phone/Fax

Practice location:
  • Phone: 312-489-4715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARVIN COKLOW
Title or Position: ASSSITANT DIREECTOR
Credential:
Phone: 773-597-7698