Provider Demographics
NPI:1609363613
Name:CHOICES RESIDENTIAL GROUP CARE INC.
Entity Type:Organization
Organization Name:CHOICES RESIDENTIAL GROUP CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:386-259-4985
Mailing Address - Street 1:5224 W STATE ROAD 46 # 325
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9230
Mailing Address - Country:US
Mailing Address - Phone:386-259-4985
Mailing Address - Fax:888-558-2226
Practice Address - Street 1:667 DELTONA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8151
Practice Address - Country:US
Practice Address - Phone:386-259-4985
Practice Address - Fax:888-558-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management