Provider Demographics
NPI:1093274706
Name:CHOICES WITH SELF DETERMINATION LLC
Entity Type:Organization
Organization Name:CHOICES WITH SELF DETERMINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RSST
Authorized Official - Phone:517-254-0017
Mailing Address - Street 1:3400 E TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:MI
Mailing Address - Zip Code:49232-9035
Mailing Address - Country:US
Mailing Address - Phone:517-254-0017
Mailing Address - Fax:517-254-4458
Practice Address - Street 1:3400 E TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:MI
Practice Address - Zip Code:49232-9035
Practice Address - Country:US
Practice Address - Phone:517-254-0017
Practice Address - Fax:517-254-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty