Healthcare Provider Details

I. General information

NPI: 1194190942
Provider Name (Legal Business Name): CHOICES UNLIMITED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3474 SE HILL RD
MILWAUKIE OR
97267-1571
US

IV. Provider business mailing address

PO BOX 1714
GRESHAM OR
97030-0533
US

V. Phone/Fax

Practice location:
  • Phone: 503-786-6211
  • Fax:
Mailing address:
  • Phone: 503-936-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number090000627RN
License Number StateOR

VIII. Authorized Official

Name: MANUELA CHRISTINA MANN
Title or Position: DIRECTOR
Credential: RN
Phone: 503-936-2818