Provider Demographics
NPI:1982033916
Name:YOUR CHOISE SERVICES, INC
Entity Type:Organization
Organization Name:YOUR CHOISE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:919-889-0012
Mailing Address - Street 1:3824 BARRETT DR
Mailing Address - Street 2:STE 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7220
Mailing Address - Country:US
Mailing Address - Phone:919-787-7423
Mailing Address - Fax:919-786-4948
Practice Address - Street 1:1035 BRISTOE DR
Practice Address - Street 2:APT 102
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6459
Practice Address - Country:US
Practice Address - Phone:919-787-7423
Practice Address - Fax:919-786-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL092673251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1659497154Medicaid