MEDICARE: YOUR CHOICE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1346644143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR CHOICE SERVICES, INC.

Provider Business Mailing Address
First Line	:	3824 BARRETT DR
Second Line	:	STE 105
City	:	RALEIGH
State	:	NC
Zip	:	27609-7220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3640 CASTLEGATE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-9551
Country	:	US
Telephone Number	:	919-217-1868
Fax Number	:

Authorized Official
Title or Position	:	ASST TREASURER
Name	:	CANDACE MONDRAGON
Credential	:
Telephone Number	:	919-889-0018

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	10/22/2014

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