Provider Demographics
NPI:1548303209
Name:CHOICES ADOLESCENT TREATMENT CTR
Entity type:Organization
Organization Name:CHOICES ADOLESCENT TREATMENT CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-938-4455
Mailing Address - Street 1:4521 KARNACK HWY
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-8734
Mailing Address - Country:US
Mailing Address - Phone:903-938-4455
Mailing Address - Fax:903-938-8906
Practice Address - Street 1:4521 KARNACK HWY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-8734
Practice Address - Country:US
Practice Address - Phone:903-938-4455
Practice Address - Fax:903-938-8906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6363245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065300801Medicaid