MEDICARE: FIRST CHOICE SERVICE FACILITATION 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1962864652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE SERVICE FACILITATION LLC

Provider Business Mailing Address
First Line	:	159 BLUEBERRY HILLS LN
Second Line	:
City	:	PATRICK SPRINGS
State	:	VA
Zip	:	24133-3875
Country	:	US
Telephone Number	:	276-288-4548
Fax Number	:	276-694-3880

Provider Business Practice Location Address
First Line	:	159 BLUEBERRY HILLS LN
Second Line	:
City	:	PATRICK SPRINGS
State	:	VA
Zip	:	24133-3875
Country	:	US
Telephone Number	:	276-288-4548
Fax Number	:	276-694-3880

Authorized Official
Title or Position	:	RN/SF/OWNER
Name	:	MRS. MELINDA ANN STOWE
Credential	:	RN
Telephone Number	:	276-288-4547

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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