Healthcare Provider Details

I. General information

NPI: 1871135947
Provider Name (Legal Business Name): CHOICE PAIN & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9123 OLD ANNAPOLIS RD STE 203-204
COLUMBIA MD
21045-1953
US

IV. Provider business mailing address

9133 OLD ANNAPOLIS RD SUITE 203-204
COLUMBIA MD
21045-1970
US

V. Phone/Fax

Practice location:
  • Phone: 410-505-8605
  • Fax:
Mailing address:
  • Phone: 410-505-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRISTAN J SHOCKLEY
Title or Position: CEO
Credential: MD
Phone: 410-505-8605