Provider Demographics
NPI:1033304522
Name:L.J. CHOICES, INC.
Entity Type:Organization
Organization Name:L.J. CHOICES, INC.
Other - Org Name:SOUTH EDINBOROUGH RESIDENTIAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-308-7331
Mailing Address - Street 1:5712 PROSPECTOR COURT
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-9372
Mailing Address - Country:US
Mailing Address - Phone:910-308-7331
Mailing Address - Fax:910-860-0594
Practice Address - Street 1:113 SOUTH EDINBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1231
Practice Address - Country:US
Practice Address - Phone:910-843-8210
Practice Address - Fax:910-860-0594
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:L.J. CHOICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-08
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-193322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604207Medicaid