Basic Information
| Provider Information | |||||||||
| NPI: | 1083778617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHOICES FOR CHILDREN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2941 TERRY RD STE 22 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392123072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252616314 | ||||||||
| FaxNumber: | 2252620226 | ||||||||
| Practice Location | |||||||||
| Address1: | 2941 TERRY RD STE 22 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392123072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252616314 | ||||||||
| FaxNumber: | 2252620226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 09/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | AUSTIN | ||||||||
| AuthorizedOfficialFirstName: | ANNETTE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2252616314 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
ID Information
| ID | Type | State | Issuer | Description | 0220145 | 05 | MS | MEDICAID |