Provider Demographics
NPI:1164143079
Name:CHOICE PAIN & REHABILITATION CENTER
Entity Type:Organization
Organization Name:CHOICE PAIN & REHABILITATION CENTER
Other - Org Name:CHOICE RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:DEANNA
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-542-3529
Mailing Address - Street 1:9123 OLD ANNAPOLIS RD STE 203&204
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1953
Mailing Address - Country:US
Mailing Address - Phone:410-806-8605
Mailing Address - Fax:
Practice Address - Street 1:9123 OLD ANNAPOLIS RD STE 203&204
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1953
Practice Address - Country:US
Practice Address - Phone:410-806-8605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICE PAIN & REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-08
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health