Provider Demographics
NPI:1164629630
Name:SELECTIVE CHOICES FOR SERVICES INC.
Entity Type:Organization
Organization Name:SELECTIVE CHOICES FOR SERVICES INC.
Other - Org Name:SELECTIVE CHOICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OWNER
Authorized Official - Phone:336-723-4222
Mailing Address - Street 1:1001 S MARSHALL ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5852
Mailing Address - Country:US
Mailing Address - Phone:336-723-4222
Mailing Address - Fax:336-723-4238
Practice Address - Street 1:1001 S MARSHALL ST
Practice Address - Street 2:SUITE 235
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5852
Practice Address - Country:US
Practice Address - Phone:336-723-4222
Practice Address - Fax:336-723-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300508BMedicaid