Provider Demographics
NPI:1669801429
Name:CHILD CARE CHOICES, INC.
Entity type:Organization
Organization Name:CHILD CARE CHOICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-251-5081
Mailing Address - Street 1:2901 CLEARWATER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-5950
Mailing Address - Country:US
Mailing Address - Phone:320-251-5081
Mailing Address - Fax:320-654-8650
Practice Address - Street 1:2901 CLEARWATER RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5950
Practice Address - Country:US
Practice Address - Phone:320-251-5081
Practice Address - Fax:320-654-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable