Provider Demographics
NPI:1245406917
Name:CHOICE SOURCE LLC
Entity type:Organization
Organization Name:CHOICE SOURCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:BORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-225-5967
Mailing Address - Street 1:1401 ELM ST FL 5 LOCKBOX 840688
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-2910
Mailing Address - Country:US
Mailing Address - Phone:800-225-5967
Mailing Address - Fax:909-799-4364
Practice Address - Street 1:909 E COLLINS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2253
Practice Address - Country:US
Practice Address - Phone:800-992-3490
Practice Address - Fax:972-619-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008085163WH0200X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty