Provider Demographics
NPI:1134365836
Name:COMMUNITY CHOICE MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:COMMUNITY CHOICE MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAIRLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:843-345-3130
Mailing Address - Street 1:3236 LANDMARK DR
Mailing Address - Street 2:109
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8488
Mailing Address - Country:US
Mailing Address - Phone:843-225-6789
Mailing Address - Fax:843-225-6789
Practice Address - Street 1:3236 LANDMARK DR
Practice Address - Street 2:109
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8488
Practice Address - Country:US
Practice Address - Phone:843-225-6789
Practice Address - Fax:843-225-6789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care