1710347547 NPI number — MAKIN' CHOICES, INC.

Table of content: (NPI 1710347547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710347547 NPI number — MAKIN' CHOICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAKIN' CHOICES, INC.
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:
1710347547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 CHAPEL HILL RD
Provider Second Line Business Mailing Address:
SUITE #23
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27707-1197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-490-8041
Provider Business Mailing Address Fax Number:
919-493-5957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 AMBER LANTERN ST
Provider Second Line Business Practice Location Address:
#203
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27613-4575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-519-3560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROOKS-BLUE
Authorized Official First Name:
RACHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICAL DIRECTOR
Authorized Official Telephone Number:
910-257-4339

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  6791 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3409018 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".