Provider Demographics
NPI:1003165309
Name:CHOICESMART-EDU,C,S,P
Entity Type:Organization
Organization Name:CHOICESMART-EDU,C,S,P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EDUCATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIMONA
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:MOROGAN CASTRO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS
Authorized Official - Phone:787-235-6947
Mailing Address - Street 1:CALLE 1 K5 URB LA MILAGROSA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-4844
Mailing Address - Country:US
Mailing Address - Phone:178-723-5694
Mailing Address - Fax:
Practice Address - Street 1:CALLE 1
Practice Address - Street 2:K5 URB LA MILAGROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-4844
Practice Address - Country:US
Practice Address - Phone:178-723-5694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities