Provider Demographics
NPI:1336399534
Name:SUPPORTED CHOICES, LLC
Entity Type:Organization
Organization Name:SUPPORTED CHOICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:502-370-7229
Mailing Address - Street 1:627 GLASS PIKE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8821
Mailing Address - Country:US
Mailing Address - Phone:502-370-7229
Mailing Address - Fax:
Practice Address - Street 1:627 GLASS PIKE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8821
Practice Address - Country:US
Practice Address - Phone:502-370-7229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities