MEDICARE: CHOICE SUPPORTED EMPLOYMENT 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	0715	UT
2	251C00000X	Developmentally Disabled Services Day Training Agency	0714	UT

General Provider Information

NPI Number	:	1700930716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE SUPPORTED EMPLOYMENT SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 12412
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84412
Country	:	US
Telephone Number	:	801-737-1744
Fax Number	:	801-737-1744

Provider Business Practice Location Address
First Line	:	3942 N 650 W
Second Line	:	COMMUNITY BASED SERVICES TO HELP FIND EMPLOYMENT COMMUN
City	:	PLEASANT VIEW
State	:	UT
Zip	:	84414
Country	:	US
Telephone Number	:	801-737-1744
Fax Number	:	801-737-1744

Authorized Official
Title or Position	:	DIRECTOR OWNER
Name	:	GEANITA A BIRKS
Credential	:
Telephone Number	:	801-737-1744

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/22/2020

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