Provider Demographics
NPI:1639624034
Name:CHOICES FOR RECOVERY, LLC
Entity Type:Organization
Organization Name:CHOICES FOR RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRITTENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-439-7498
Mailing Address - Street 1:417 S SHARON AMITY RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2883
Mailing Address - Country:US
Mailing Address - Phone:704-365-4170
Mailing Address - Fax:
Practice Address - Street 1:200 QUEENS RD STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3252
Practice Address - Country:US
Practice Address - Phone:980-237-6990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-1317305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service