=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922666882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CHOICE HOME HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2019
-----------------------------------------------------
Last Update Date | 06/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 IMPERIAL BLVD STE 11
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37075-3441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-562-3244
-----------------------------------------------------
Fax | 844-324-3244
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1585
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37077-1585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. MARK OSBORNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-562-3244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------