1962884395 NPI number — FIRST CHOICE HEALTH CENTERS, INC.

Table of content: (NPI 1962884395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962884395 NPI number — FIRST CHOICE HEALTH CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE HEALTH CENTERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962884395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 CONNECTICUT BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-610-6131
Provider Business Mailing Address Fax Number:
860-290-4142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 CENTER ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06040-3926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-610-6131
Provider Business Practice Location Address Fax Number:
860-290-4142
Provider Enumeration Date:
06/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MARKET
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
860-610-6131

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  0816 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004236164 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com