Provider Demographics
NPI:1700930716
Name:CHOICE SUPPORTED EMPLOYMENT SERVICES INC
Entity Type:Organization
Organization Name:CHOICE SUPPORTED EMPLOYMENT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEANITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIRKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-737-1744
Mailing Address - Street 1:PO BOX 12412
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84412
Mailing Address - Country:US
Mailing Address - Phone:801-737-1744
Mailing Address - Fax:801-737-1744
Practice Address - Street 1:3942 N 650 W
Practice Address - Street 2:COMMUNITY BASED SERVICES TO HELP FIND EMPLOYMENT COMMUN
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84414
Practice Address - Country:US
Practice Address - Phone:801-737-1744
Practice Address - Fax:801-737-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0715251C00000X
UT0714251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========002Medicaid