Provider Demographics
NPI:1760079545
Name:1ST CHOICE ORGANIZATION HOUSE OF 1ST CHOICE
Entity Type:Organization
Organization Name:1ST CHOICE ORGANIZATION HOUSE OF 1ST CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-942-1127
Mailing Address - Street 1:3837 VAILE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2210
Mailing Address - Country:US
Mailing Address - Phone:314-942-1127
Mailing Address - Fax:314-279-1006
Practice Address - Street 1:3837 VAILE AVE STE D
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2210
Practice Address - Country:US
Practice Address - Phone:314-942-1127
Practice Address - Fax:314-279-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)