Provider Demographics
NPI:1952986325
Name:SHELLYS WRIGHT CHOICE LLC
Entity Type:Organization
Organization Name:SHELLYS WRIGHT CHOICE LLC
Other - Org Name:SHELLYS WRIGHT CHOICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KYISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-243-0352
Mailing Address - Street 1:1731 HIGHWAY 42 N
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4725
Mailing Address - Country:US
Mailing Address - Phone:678-918-9955
Mailing Address - Fax:470-412-6027
Practice Address - Street 1:1731 HIGHWAY 42 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4725
Practice Address - Country:US
Practice Address - Phone:678-918-9955
Practice Address - Fax:470-412-6027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003263327AMedicaid