Provider Demographics
NPI:1104127885
Name:CHOICE COMMUNITY LIVING SERVICES
Entity type:Organization
Organization Name:CHOICE COMMUNITY LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANDRA
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-801-4247
Mailing Address - Street 1:7719 FALCON REST CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2561
Mailing Address - Country:US
Mailing Address - Phone:919-801-4247
Mailing Address - Fax:
Practice Address - Street 1:1037 WHETSTONE CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5827
Practice Address - Country:US
Practice Address - Phone:919-801-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness