Healthcare Provider Details

I. General information

NPI: 1104127885
Provider Name (Legal Business Name): CHOICE COMMUNITY LIVING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 WHETSTONE CT
RALEIGH NC
27615-5827
US

IV. Provider business mailing address

7719 FALCON REST CIR
RALEIGH NC
27615-2561
US

V. Phone/Fax

Practice location:
  • Phone: 919-801-4247
  • Fax:
Mailing address:
  • Phone: 919-801-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANDRA JONES ROSS
Title or Position: OWNER/OPERATIONS MANAGER
Credential:
Phone: 919-801-4247