Provider Demographics
NPI:1083769533
Name:CITIZENS CHOICE PHYSIOCARE, INC.
Entity Type:Organization
Organization Name:CITIZENS CHOICE PHYSIOCARE, INC.
Other - Org Name:CITIZENS CHOICE HOME CARE SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-650-6651
Mailing Address - Street 1:5865 RIDGEWAY CENTER PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-650-6651
Mailing Address - Fax:901-767-5544
Practice Address - Street 1:5865 RIDGEWAY CENTER PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-650-6651
Practice Address - Fax:901-767-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000013310251J00000X
TNL000000013311251S00000X
261QP2000X, 342000000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445458Medicaid