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General NPI Number Information
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NPI Number | 1215523790
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Entity Type | Organization
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Legal Business Name | MY CHOICE, LLC
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Dates
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Enumeration Date | 12/18/2020
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 12900 SNOW RD
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City | CLEVELAND
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State | OH
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Zip | 44130-1012
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Country | US
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Telephone | 133-024-2627
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Fax |
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Provider Business Mailing Address
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Address Line | 1860 MATTINGLY RD
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City | HINCKLEY
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State | OH
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Zip | 44233-9426
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Country | US
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Telephone | 330-242-6272
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | BRITTANY MATISAK
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Credential |
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Telephone | 330-242-6272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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