Healthcare Provider Details

I. General information

NPI: 1972886612
Provider Name (Legal Business Name): FIRST CHOICE CHICAGO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9999 W ROOSEVELT RD SUITE 101
WESTCHESTER IL
60154-2775
US

IV. Provider business mailing address

9999 W ROOSEVELT RD SUITE 101
WESTCHESTER IL
60154-2775
US

V. Phone/Fax

Practice location:
  • Phone: 708-938-5238
  • Fax: 708-938-5239
Mailing address:
  • Phone: 708-938-5238
  • Fax: 708-938-5239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VELMA SMITH
Title or Position: MANAGER
Credential:
Phone: 708-938-5238