MEDICARE: 1ST CHOICE DAY HAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1508226754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST CHOICE DAY HAB

Provider Business Mailing Address
First Line	:	1915 HEATHER GLEN DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-2313
Country	:	US
Telephone Number	:	214-677-5221
Fax Number	:	214-330-6194

Provider Business Practice Location Address
First Line	:	4210 S WESTMORELAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-3720
Country	:	US
Telephone Number	:	214-677-5221
Fax Number	:	214-330-6194

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. ODILE CATHERINE BLEDSOE
Credential	:
Telephone Number	:	214-677-5221

Provider Enumeration Date	:	03/01/2016
Last Update Date	:	03/01/2016

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