Healthcare Provider Details

I. General information

NPI: 1457540361
Provider Name (Legal Business Name): FIRST CHOICE COMMUNITY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 EXECUTIVE CENTER DR STE 204
CHARLOTTE NC
28212-8856
US

IV. Provider business mailing address

5500 EXECUTIVE CENTER DR STE 204
CHARLOTTE NC
28212-8856
US

V. Phone/Fax

Practice location:
  • Phone: 704-535-4342
  • Fax: 704-535-4347
Mailing address:
  • Phone: 704-535-4342
  • Fax: 704-535-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberMHL-060-1266
License Number StateNC

VIII. Authorized Official

Name: MS. LISA BROWN-SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED.
Phone: 704-535-4342