Provider Demographics
NPI:1467599878
Name:COMMUNITY LIVING AND CHOICES
Entity Type:Organization
Organization Name:COMMUNITY LIVING AND CHOICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:LAVAR
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-852-4428
Mailing Address - Street 1:318 S SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4379
Mailing Address - Country:US
Mailing Address - Phone:704-852-4428
Mailing Address - Fax:
Practice Address - Street 1:318 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4379
Practice Address - Country:US
Practice Address - Phone:704-852-4428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBELVEDERE MHL023061320600000X
NCWACO MHL023111320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300897Medicaid
NC6603926Medicaid