Provider Demographics
NPI:1083094056
Name:FIRSTCHOICE HEALTH CARE INC
Entity Type:Organization
Organization Name:FIRSTCHOICE HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KENNY
Authorized Official - Middle Name:ADESHOLA
Authorized Official - Last Name:AMANZE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:301-494-4770
Mailing Address - Street 1:2409 BAIKAL LOOP
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7051
Mailing Address - Country:US
Mailing Address - Phone:301-494-4770
Mailing Address - Fax:240-342-3440
Practice Address - Street 1:2409 BAIKAL LOOP
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7051
Practice Address - Country:US
Practice Address - Phone:301-494-4770
Practice Address - Fax:240-342-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3713251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD423698000Medicaid