Provider Demographics
NPI:1033754189
Name:THE CHOSEN ONE 23:4 INC
Entity Type:Organization
Organization Name:THE CHOSEN ONE 23:4 INC
Other - Org Name:THE CHOSEN ONE 23:4 INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARCILLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-488-3121
Mailing Address - Street 1:1725 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3022
Mailing Address - Country:US
Mailing Address - Phone:407-488-3121
Mailing Address - Fax:
Practice Address - Street 1:1725 JORDAN DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3022
Practice Address - Country:US
Practice Address - Phone:407-488-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty