=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396261459
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CHOICE HOME HEALTH & BEHAVIORAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2017
-----------------------------------------------------
Last Update Date | 08/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3308 ELEBASH HL
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36106-3476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-707-0821
-----------------------------------------------------
Fax | 832-707-0821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25506 SUNFLOWER SPRINGS CT
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77373-8437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-707-0821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | CYNTHIA JEFFERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-707-0821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------