Provider Demographics
NPI:1558068007
Name:MY CHOICE CASE MANAGEMENT
Entity Type:Organization
Organization Name:MY CHOICE CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-440-4037
Mailing Address - Street 1:108 ROYAL ST STE A
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1724
Mailing Address - Country:US
Mailing Address - Phone:304-440-4037
Mailing Address - Fax:
Practice Address - Street 1:108 ROYAL ST STE A
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1724
Practice Address - Country:US
Practice Address - Phone:304-440-4037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV364676Medicaid