MEDICARE: FIRST CHOICE CARE SERVICES, INC

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	253Z00000X	In Home Supportive Care Agency	22133601	PA

General Provider Information

NPI Number	:	1578825477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	4912 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-4224
Country	:	US
Telephone Number	:	215-324-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	4912 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-4224
Country	:	US
Telephone Number	:	215-324-1414
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. YAMILETTE MONTES
Credential	:
Telephone Number	:	267-228-0251

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	06/15/2012

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