Provider Demographics
NPI:1972023711
Name:1ST CHOICE RESIDENTIAL LLC
Entity Type:Organization
Organization Name:1ST CHOICE RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-252-2632
Mailing Address - Street 1:500 S JEAN DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-5343
Mailing Address - Country:US
Mailing Address - Phone:903-471-0589
Mailing Address - Fax:903-708-6217
Practice Address - Street 1:500 S JEAN DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-5343
Practice Address - Country:US
Practice Address - Phone:903-471-0589
Practice Address - Fax:903-708-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services