Healthcare Provider Details

I. General information

NPI: 1013323872
Provider Name (Legal Business Name): FIRST CHOICE SUPPORTIVE SERVICES, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3423 SUMMERLIN PARKWAY
LITHIA SPRINGS GA
30122
US

IV. Provider business mailing address

3423 SUMMERLIN PARKWAY
LITHIA SPRINGS GA
30122
US

V. Phone/Fax

Practice location:
  • Phone: 404-437-9548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. LATANYA SLOAN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 404-437-9548