Provider Demographics
NPI:1104064542
Name:CHOICECARE HOMECARE AGNECY
Entity type:Organization
Organization Name:CHOICECARE HOMECARE AGNECY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEACE
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-338-9928
Mailing Address - Street 1:3306 CLAYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3482
Mailing Address - Country:US
Mailing Address - Phone:849-338-9928
Mailing Address - Fax:
Practice Address - Street 1:3325 BEAUMONT CENTRE CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1954
Practice Address - Country:US
Practice Address - Phone:859-338-9928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251E00000X, 251K00000X, 253Z00000X
KY251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherTAX ID