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General NPI Number Information
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NPI Number | 1972023711
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Entity Type | Organization
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Legal Business Name | 1ST CHOICE RESIDENTIAL LLC
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 500 S JEAN DR
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City | LONGVIEW
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State | TX
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Zip | 75602-5343
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Country | US
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Telephone | 903-471-0589
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Fax | 903-708-6217
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Provider Business Mailing Address
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Address Line | 500 S JEAN DR
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City | LONGVIEW
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State | TX
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Zip | 75602-5343
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Country | US
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Telephone | 903-471-0589
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Fax | 903-708-6217
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KRISTY R DUFFIE
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Credential |
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Telephone | 903-252-2632
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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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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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