Provider Demographics
NPI:1083471171
Name:CHOICE SELECT HOME CARE
Entity Type:Organization
Organization Name:CHOICE SELECT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-947-0777
Mailing Address - Street 1:1513 E 13TH AVE APT A
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3473
Mailing Address - Country:US
Mailing Address - Phone:229-947-0777
Mailing Address - Fax:
Practice Address - Street 1:1513 E 13TH AVE APT A
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3473
Practice Address - Country:US
Practice Address - Phone:229-947-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care