Healthcare Provider Details

I. General information

NPI: 1558804070
Provider Name (Legal Business Name): FIRST CHOICE HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 UNION SREET 2ND FLOOR
VERNON CT
06066
US

IV. Provider business mailing address

94 CONNECTICUT BOULEVARD
EAST HARTFORD CT
06108
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-1359
  • Fax: 860-290-4142
Mailing address:
  • Phone: 860-528-1359
  • Fax: 860-290-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number0783
License Number StateCT

VIII. Authorized Official

Name: EUGENE A MARKET
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 860-610-6131