Provider Demographics
NPI:1518011063
Name:CHOICE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:CHOICE HOME HEALTH CARE INC
Other - Org Name:CHOICE HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:FETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-544-0044
Mailing Address - Street 1:5858 GATEWAY BLVD E
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1923
Mailing Address - Country:US
Mailing Address - Phone:915-544-0044
Mailing Address - Fax:915-544-1888
Practice Address - Street 1:5858 GATEWAY BLVD E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-1923
Practice Address - Country:US
Practice Address - Phone:915-544-0044
Practice Address - Fax:915-544-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007532251E00000X
TX012250251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152120501Medicaid
TX679092Medicare Oscar/Certification