Provider Demographics
NPI:1710047170
Name:FIRST CHOICE HEALTHCARE SERVICES,INC
Entity Type:Organization
Organization Name:FIRST CHOICE HEALTHCARE SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAEHIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-507-6271
Mailing Address - Street 1:3225 W PETERSON AVE
Mailing Address - Street 2:T-18
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3621
Mailing Address - Country:US
Mailing Address - Phone:773-338-9844
Mailing Address - Fax:773-338-9845
Practice Address - Street 1:3525 W PETERSON AVE
Practice Address - Street 2:T-18
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4668
Practice Address - Country:US
Practice Address - Phone:773-338-9844
Practice Address - Fax:773-338-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1473766332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL4697760001Medicare ID - Type Unspecified