=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942492012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY CHOICE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2007
-----------------------------------------------------
Last Update Date | 08/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1251 E DOROTHY LN
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45419-2106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-298-1111
-----------------------------------------------------
Fax | 937-298-7210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1251 E DOROTHY LN
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45419-2106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-298-1111
-----------------------------------------------------
Fax | 937-298-7210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | WARREN D GANZSARTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-298-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------