Provider Demographics
NPI:1699154526
Name:CHOICE COMMUNITY SUPPORT INC
Entity type:Organization
Organization Name:CHOICE COMMUNITY SUPPORT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-365-0101
Mailing Address - Street 1:8313 SOUTHWEST FWY
Mailing Address - Street 2:112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-365-0101
Mailing Address - Fax:832-365-7986
Practice Address - Street 1:8313 SOUTHWEST FWY
Practice Address - Street 2:112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1611
Practice Address - Country:US
Practice Address - Phone:713-365-0101
Practice Address - Fax:832-365-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251K00000X, 343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251K00000XAgenciesPublic Health or Welfare
No347C00000XTransportation ServicesPrivate Vehicle