Provider Demographics
NPI:1891150496
Name:CHOICE MEDICAL AND GERIATRIC CARE INC
Entity Type:Organization
Organization Name:CHOICE MEDICAL AND GERIATRIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ATIGBI-HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:631-965-2130
Mailing Address - Street 1:242 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1840
Mailing Address - Country:US
Mailing Address - Phone:877-864-8482
Mailing Address - Fax:
Practice Address - Street 1:170 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STANFIELD
Practice Address - State:OR
Practice Address - Zip Code:97875-2072
Practice Address - Country:US
Practice Address - Phone:778-864-8482
Practice Address - Fax:470-377-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty