Provider Demographics
NPI: | 1841390630 |
---|---|
Name: | COMMUNITY CHOICES |
Entity Type: | Organization |
Organization Name: | COMMUNITY CHOICES |
Other - Org Name: | COMMUNITY CHOICES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | EDEN |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | LUSTIG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSED |
Authorized Official - Phone: | 702-388-8805 |
Mailing Address - Street 1: | 3925 N. MARTIN LUTHER KING BLVD. #210 |
Mailing Address - Street 2: | |
Mailing Address - City: | NORTH LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89032 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-388-8805 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3925 N. MARTIN LUTHER KING BLVD. UNIT 201 |
Practice Address - Street 2: | |
Practice Address - City: | NORTH LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89032 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-388-8805 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-22 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 251E00000X | Agencies | Home Health | |
Not Answered | 251V00000X | Agencies | Voluntary or Charitable |