Provider Demographics
NPI:1720406424
Name:YOUR CHOICE SUPPORT COORDINATION, INC.
Entity Type:Organization
Organization Name:YOUR CHOICE SUPPORT COORDINATION, INC.
Other - Org Name:VALERIE REED-MARTIN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REED-MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-477-2954
Mailing Address - Street 1:3608 ELK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6354
Mailing Address - Country:US
Mailing Address - Phone:813-477-2954
Mailing Address - Fax:800-590-3552
Practice Address - Street 1:3608 ELK RIDGE LN
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6354
Practice Address - Country:US
Practice Address - Phone:813-477-2954
Practice Address - Fax:800-590-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty