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General NPI Number Information
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NPI Number | 1730851593
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Entity Type | Organization
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Legal Business Name | CHOICE LIVING COMMUNITY
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 3875 S STAPLES ST STE 4
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-2378
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Country | US
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Telephone | 361-510-0672
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 71387
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City | CORPUS CHRISTI
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State | TX
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Zip | 78467-1387
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Country | US
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Telephone | 361-510-0672
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JENNIFER SCOTT
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Credential |
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Telephone | 361-510-0672
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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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