Provider Demographics
NPI:1508853169
Name:FIRST CHOICE HOME MEDICAL, INC.
Entity Type:Organization
Organization Name:FIRST CHOICE HOME MEDICAL, INC.
Other - Org Name:GEARY COMMUNITY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:CRUZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT OF COMPANY
Authorized Official - Phone:405-802-4483
Mailing Address - Street 1:P.O. BOX 47
Mailing Address - Street 2:720 N. GALENA ST.
Mailing Address - City:GEARY
Mailing Address - State:OK
Mailing Address - Zip Code:73040-2801
Mailing Address - Country:US
Mailing Address - Phone:405-884-5440
Mailing Address - Fax:405-884-2749
Practice Address - Street 1:720 N GALENA
Practice Address - Street 2:
Practice Address - City:GEARY
Practice Address - State:OK
Practice Address - Zip Code:73040-2801
Practice Address - Country:US
Practice Address - Phone:405-884-5440
Practice Address - Fax:405-884-5439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CHOICE HOME MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH0602-0602313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100773370AMedicaid
OK200117080AMedicaid
OK100773370AMedicaid