Healthcare Provider Details

I. General information

NPI: 1669874855
Provider Name (Legal Business Name): FIRST CHOICE HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAPLE STREET MAPLE STREET SCHOOL
VERNON CT
06066
US

IV. Provider business mailing address

94 CONNECTICUT BOULEVARD
EAST HARTFORD CT
06108
US

V. Phone/Fax

Practice location:
  • Phone: 860-647-6592
  • Fax: 860-290-4142
Mailing address:
  • Phone: 860-610-6131
  • Fax: 860-290-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number0734
License Number StateCT

VIII. Authorized Official

Name: EUGENE A MARKET
Title or Position: CEO
Credential:
Phone: 860-610-6131