Healthcare Provider Details

I. General information

NPI: 1033304522
Provider Name (Legal Business Name): L.J. CHOICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SOUTH EDINBOROUGH ST
RED SPRINGS NC
28377-1231
US

IV. Provider business mailing address

5712 PROSPECTOR COURT
HOPE MILLS NC
28348-9372
US

V. Phone/Fax

Practice location:
  • Phone: 910-843-8210
  • Fax: 910-860-0594
Mailing address:
  • Phone: 910-308-7331
  • Fax: 910-860-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-078-193
License Number StateNC

VIII. Authorized Official

Name: LINDA S JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 910-308-7331