Provider Demographics
NPI:1417286527
Name:INDEPENDENT CHOICES, INC.
Entity Type:Organization
Organization Name:INDEPENDENT CHOICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-732-0155
Mailing Address - Street 1:1854 E PERRY ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1578
Mailing Address - Country:US
Mailing Address - Phone:419-732-0155
Mailing Address - Fax:419-732-0265
Practice Address - Street 1:1854 E. PERRY ST.
Practice Address - Street 2:
Practice Address - City:PORT CLINOTN
Practice Address - State:OH
Practice Address - Zip Code:43452
Practice Address - Country:US
Practice Address - Phone:419-732-0155
Practice Address - Fax:419-732-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2026480Medicaid