Provider Demographics
NPI:1053457713
Name:PARENTS CHOICE CARE SERVICES
Entity Type:Organization
Organization Name:PARENTS CHOICE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:L
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, BS
Authorized Official - Phone:252-413-8487
Mailing Address - Street 1:502 DEXTER ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6314
Mailing Address - Country:US
Mailing Address - Phone:252-756-4955
Mailing Address - Fax:252-756-4994
Practice Address - Street 1:502 DEXTER ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6314
Practice Address - Country:US
Practice Address - Phone:252-756-4955
Practice Address - Fax:252-756-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301784Medicaid