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General NPI Number Information
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NPI Number | 1720623077
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Entity Type | Organization
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Legal Business Name | FIRST CHOICE GROUP HOME INC
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Dates
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Enumeration Date | 11/11/2019
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 750 SW 108TH AVE # 35-307
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-7126
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Country | US
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Telephone | 786-541-4691
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Fax |
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Provider Business Mailing Address
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Address Line | 750 SW 108TH AVE # 35-307
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-7126
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Country | US
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Telephone | 786-541-4691
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KEVIN MOREAU
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Credential |
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Telephone | 786-541-4691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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