Provider Demographics
NPI:1124357074
Name:CLEAR CHOICES, LLC
Entity Type:Organization
Organization Name:CLEAR CHOICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SKANTZOS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, BSSE
Authorized Official - Phone:724-775-7905
Mailing Address - Street 1:373 CLEVELAND ST
Mailing Address - Street 2:PO BOX 368
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-1623
Mailing Address - Country:US
Mailing Address - Phone:724-775-7905
Mailing Address - Fax:724-775-7907
Practice Address - Street 1:373 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-1623
Practice Address - Country:US
Practice Address - Phone:724-775-7905
Practice Address - Fax:724-775-7907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA047052261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone