Provider Demographics
NPI:1699431015
Name:CHOICE SERVICES GROUP LLC
Entity type:Organization
Organization Name:CHOICE SERVICES GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OPEOLUWA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYOBANDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-649-1686
Mailing Address - Street 1:232 S PROGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:232 S PROGRESS AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4626
Practice Address - Country:US
Practice Address - Phone:717-649-1686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care