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General NPI Number Information
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NPI Number | 1235369182
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Entity Type | Organization
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Legal Business Name | CHOICES HEALTH CENTER, INC.
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 747 FAWN RIDGE DR SUITE 100
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City | ORANGE CITY
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State | FL
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Zip | 32763-8268
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Country | US
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Telephone | 386-456-1047
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Fax | 866-707-3476
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Provider Business Mailing Address
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Address Line | 747 FAWN RIDGE DR SUITE 100
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City | ORANGE CITY
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State | FL
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Zip | 32763-8268
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Country | US
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Telephone | 386-456-1047
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Fax | 866-707-3476
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Authorized Official
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Title or Position | COO
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Name | MR. SHANE E WILSON
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Credential |
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Telephone | 386-456-1047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC7157
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License Number State | FL
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