Provider Demographics
NPI:1396216495
Name:FIRST CHOICE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:FIRST CHOICE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KOMETA
Authorized Official - Last Name:NGWAFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-904-5237
Mailing Address - Street 1:14802 BOWIE FARM CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-6226
Mailing Address - Country:US
Mailing Address - Phone:202-904-5237
Mailing Address - Fax:
Practice Address - Street 1:14802 BOWIE FARM CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-6226
Practice Address - Country:US
Practice Address - Phone:202-904-5237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037934200Medicaid