MEDICARE: FIRST CHOICE CAREGIVERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1982048302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE CAREGIVERS

Provider Business Mailing Address
First Line	:	12450 MAGNOLIA BLVD
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-2451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12450 MAGNOLIA BLVD
Second Line	:	STE 4074
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:	323-656-8266
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MICHAEL JUDAH
Credential	:
Telephone Number	:	323-656-8266

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	04/29/2013

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