Healthcare Provider Details

I. General information

NPI: 1609308964
Provider Name (Legal Business Name): MYCHOICE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13020 TILDEN RD
HIRAM OH
44234-9725
US

IV. Provider business mailing address

PO BOX 329
GARRETTSVILLE OH
44231-0329
US

V. Phone/Fax

Practice location:
  • Phone: 330-297-7931
  • Fax:
Mailing address:
  • Phone: 330-297-7931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RUTH SKOCIC
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 330-297-7931