Provider Demographics
NPI:1295100964
Name:CHOSEN HEALTH CARE SERVICES INC
Entity type:Organization
Organization Name:CHOSEN HEALTH CARE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:NONYELUM
Authorized Official - Last Name:MUONAGOLU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-547-1988
Mailing Address - Street 1:8401 UNIVERSITY EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1360
Mailing Address - Country:US
Mailing Address - Phone:704-547-1988
Mailing Address - Fax:
Practice Address - Street 1:705B WESLEY PINES ROAD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-674-4592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOSEN HEALTH CARE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-07
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4222253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care