=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508145921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CHOICE HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2011
-----------------------------------------------------
Last Update Date | 08/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 CAPITOL ST SUITE 1003
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25301-1749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-344-2256
-----------------------------------------------------
Fax | 304-344-2263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3324
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25333-3324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-344-2256
-----------------------------------------------------
Fax | 304-344-2263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | STEVE L BURTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-344-2213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------