Provider Demographics
NPI:1851030019
Name:SMART CHOICE MEDICAL GROUP
Entity Type:Organization
Organization Name:SMART CHOICE MEDICAL GROUP
Other - Org Name:SMART CHOICE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LASHANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-329-8288
Mailing Address - Street 1:12926 RILEY CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8850
Mailing Address - Country:US
Mailing Address - Phone:909-329-8288
Mailing Address - Fax:
Practice Address - Street 1:4200 LATHAM ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1766
Practice Address - Country:US
Practice Address - Phone:909-329-8288
Practice Address - Fax:562-309-8477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW BEGINNINGS REINTEGRATION AND CONTINUUM CARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-03
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100131983Medicaid