Provider Demographics
NPI:1265807192
Name:CHOICES CENTER FOR INDEPENDENT LIVING INC.
Entity type:Organization
Organization Name:CHOICES CENTER FOR INDEPENDENT LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-627-6727
Mailing Address - Street 1:1717 W 2ND ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-2000
Mailing Address - Country:US
Mailing Address - Phone:575-627-6727
Mailing Address - Fax:575-627-6754
Practice Address - Street 1:1717 W 2ND ST
Practice Address - Street 2:SUITE 115
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-2000
Practice Address - Country:US
Practice Address - Phone:575-627-6727
Practice Address - Fax:575-627-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management