Provider Demographics
NPI:1093150328
Name:SELF-DIRECTED CHOICES, LLC
Entity Type:Organization
Organization Name:SELF-DIRECTED CHOICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SKAAR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:505-508-1663
Mailing Address - Street 1:3909 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3992
Mailing Address - Country:US
Mailing Address - Phone:505-508-1663
Mailing Address - Fax:888-541-7076
Practice Address - Street 1:3909 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3992
Practice Address - Country:US
Practice Address - Phone:505-508-1663
Practice Address - Fax:888-541-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09285211Medicaid