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General NPI Number Information
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NPI Number | 1811539158
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Entity Type | Organization
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Legal Business Name | CHOICES COORDINATED CARE SOLUTIONS, INC.
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 302 COURTHOUSE RD STE G
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City | GULFPORT
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State | MS
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Zip | 39507-1890
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Country | US
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Telephone | 318-464-2561
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Fax |
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Provider Business Mailing Address
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Address Line | 302 COURTHOUSE RD STE G
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City | GULFPORT
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State | MS
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Zip | 39507-1890
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Country | US
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Telephone | 318-464-2561
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MICHAEL HOWARD GOLDBERG
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Credential |
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Telephone | 314-517-6005
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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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