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General NPI Number Information
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NPI Number | 1942065743
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Entity Type | Organization
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Legal Business Name | CHOSEN ONE - TDC
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 10502 MARIONS WAY
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City | GLEN ALLEN
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State | VA
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Zip | 23060-4009
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Country | US
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Telephone | 804-517-4411
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Fax | 804-261-2186
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Provider Business Mailing Address
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Address Line | 10502 MARIONS WAY
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City | GLEN ALLEN
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State | VA
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Zip | 23060-4009
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Country | US
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Telephone | 804-517-4411
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Fax | 804-261-2186
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Authorized Official
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Title or Position | SERVICE FACILITATOR
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Name | TYQUAN CHURCHWELL
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Credential |
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Telephone | 804-517-4411
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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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