Provider Demographics
NPI:1891851010
Name:EXPANDING CHOICES INC
Entity Type:Organization
Organization Name:EXPANDING CHOICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:RATERINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-340-0700
Mailing Address - Street 1:6100 UPTOWN BLVD NE STE 650
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4186
Mailing Address - Country:US
Mailing Address - Phone:505-340-0700
Mailing Address - Fax:505-340-0701
Practice Address - Street 1:6100 UPTOWN BLVD NE STE 650
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4186
Practice Address - Country:US
Practice Address - Phone:505-340-0700
Practice Address - Fax:505-340-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0271261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM72579081Medicaid
NM6005223272Medicare PIN
NMI05834Medicare UPIN