Provider Demographics
NPI:1063170553
Name:CHOICEPOINT LLC
Entity type:Organization
Organization Name:CHOICEPOINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KACZKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-853-6460
Mailing Address - Street 1:6586 ATLANTIC AVE # 4872
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1617
Mailing Address - Country:US
Mailing Address - Phone:844-445-2563
Mailing Address - Fax:
Practice Address - Street 1:23-00 ROUTE 208 STE 2-9
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1558
Practice Address - Country:US
Practice Address - Phone:844-445-2563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty