Provider Demographics
NPI:1639448723
Name:FIRST CHOICE ADULT DAYCARE AND HOME HEALTH CA
Entity Type:Organization
Organization Name:FIRST CHOICE ADULT DAYCARE AND HOME HEALTH CA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MILEY-PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CMA, CNA
Authorized Official - Phone:904-525-2918
Mailing Address - Street 1:5336 QUAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205
Mailing Address - Country:US
Mailing Address - Phone:904-525-2918
Mailing Address - Fax:
Practice Address - Street 1:5336 QUAN DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205
Practice Address - Country:US
Practice Address - Phone:904-525-2918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CHOICEADULT DAYCARE AND HOME HEALTH CARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
641306NCMA174400000X
FL103413CNA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty