Provider Demographics
NPI:1003988411
Name:CHOICES GROUP HOME, INC.
Entity Type:Organization
Organization Name:CHOICES GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-244-4263
Mailing Address - Street 1:897 STATE CAMP RD
Mailing Address - Street 2:
Mailing Address - City:VANCEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28586-8451
Mailing Address - Country:US
Mailing Address - Phone:252-244-4263
Mailing Address - Fax:
Practice Address - Street 1:897 STATE CAMP RD
Practice Address - Street 2:
Practice Address - City:VANCEBORO
Practice Address - State:NC
Practice Address - Zip Code:28586-8451
Practice Address - Country:US
Practice Address - Phone:252-244-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-025-206320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities