Healthcare Provider Details

I. General information

NPI: 1891150496
Provider Name (Legal Business Name): CHOICE MEDICAL AND GERIATRIC CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 01/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 S MAIN ST
STANFIELD OR
97875-2072
US

IV. Provider business mailing address

242 E MAIN ST
HERMISTON OR
97838-1840
US

V. Phone/Fax

Practice location:
  • Phone: 778-864-8482
  • Fax: 470-377-8102
Mailing address:
  • Phone: 877-864-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUETH ATIGBI-HANSEN
Title or Position: OWNER
Credential: NP
Phone: 631-965-2130