Provider Demographics
NPI:1982971297
Name:CHOICES ETC.LLC
Entity Type:Organization
Organization Name:CHOICES ETC.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-806-8184
Mailing Address - Street 1:545 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49070-9740
Mailing Address - Country:US
Mailing Address - Phone:269-672-2149
Mailing Address - Fax:269-672-2149
Practice Address - Street 1:545 119TH AVE
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:MI
Practice Address - Zip Code:49070-9740
Practice Address - Country:US
Practice Address - Phone:269-672-2149
Practice Address - Fax:269-672-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID4278M251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0049746Medicaid