MEDICARE: FIRST CHOICE FAMILY LLC

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	251E00000X	Home Health Agency	2009-38961-38101	SC

General Provider Information

NPI Number	:	1932433562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE FAMILY LLC

Provider Business Mailing Address
First Line	:	2816 KNIGHTBRIDGE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2127
Country	:	US
Telephone Number	:	803-413-9259
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 KNIGHTBRIDGE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-2127
Country	:	US
Telephone Number	:	803-413-9259
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SELASIA NATASHA JENKINS
Credential	:
Telephone Number	:	803-413-9259

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	09/30/2009

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