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General NPI Number Information
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NPI Number | 1609363613
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Entity Type | Organization
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Legal Business Name | CHOICES RESIDENTIAL GROUP CARE INC.
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 04/16/2018
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Provider Practice Location Address
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Address Line | 667 DELTONA BLVD STE 101
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City | DELTONA
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State | FL
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Zip | 32725-8151
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Country | US
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Telephone | 386-259-4985
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Fax | 888-558-2226
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Provider Business Mailing Address
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Address Line | 5224 W STATE ROAD 46 # 325
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City | SANFORD
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State | FL
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Zip | 32771-9230
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Country | US
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Telephone | 386-259-4985
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Fax | 888-558-2226
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Authorized Official
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Title or Position | CLINICAL SERVICES DIRECTOR
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Name | MR. SHANNON L THOMAS SR.
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Credential |
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Telephone | 386-259-4985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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