1265771604 NPI number — CHOICES RECOVERY SERVICES, LLC

Table of content: (NPI 1265771604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265771604 NPI number — CHOICES RECOVERY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICES RECOVERY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265771604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2298
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINEVILLE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97754-0470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-504-7535
Provider Business Mailing Address Fax Number:
541-504-7535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
357 NE COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINEVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97754-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-504-7535
Provider Business Practice Location Address Fax Number:
541-504-7535
Provider Enumeration Date:
02/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BYUS
Authorized Official First Name:
DARLA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
541-504-7535

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 1543364-8 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500662204 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500772430 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500654390 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 278974 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500743475 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500770685 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500779958 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500771685 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500210831 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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