Provider Demographics
NPI:1386127363
Name:CHOICE HEALTH CO LLC
Entity type:Organization
Organization Name:CHOICE HEALTH CO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:209-485-3365
Mailing Address - Street 1:315 W SOUTH BOULDER RD STE 109
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1157
Mailing Address - Country:US
Mailing Address - Phone:209-485-3365
Mailing Address - Fax:
Practice Address - Street 1:315 W SOUTH BOULDER RD STE 109
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1157
Practice Address - Country:US
Practice Address - Phone:209-485-3365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health