Provider Demographics
NPI:1114163847
Name:CHOICES FAMILY EDUCATION SERVICES OF WI LLC
Entity Type:Organization
Organization Name:CHOICES FAMILY EDUCATION SERVICES OF WI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:FEARS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:920-698-0821
Mailing Address - Street 1:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0915
Mailing Address - Country:US
Mailing Address - Phone:920-698-0821
Mailing Address - Fax:
Practice Address - Street 1:328 MILL ST
Practice Address - Street 2:
Practice Address - City:HOWARDS GROVE
Practice Address - State:WI
Practice Address - Zip Code:53083-1219
Practice Address - Country:US
Practice Address - Phone:920-698-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42213600Medicaid