Provider Demographics
NPI:1922369420
Name:1ST CHOICE CARE SERVICES LLC
Entity Type:Organization
Organization Name:1ST CHOICE CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA.BLS.CPR.FIRST AID
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:313-316-9908
Mailing Address - Street 1:17208 LITTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-4111
Mailing Address - Country:US
Mailing Address - Phone:313-316-9908
Mailing Address - Fax:248-559-8141
Practice Address - Street 1:17208 LITTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-4111
Practice Address - Country:US
Practice Address - Phone:313-316-9908
Practice Address - Fax:248-559-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI302F00000X302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI370347599Medicare Oscar/Certification