Provider Demographics
NPI:1003621392
Name:FIRST CHOICE DEVELOPMENTAL DISABILITY SERVICES, LLC
Entity type:Organization
Organization Name:FIRST CHOICE DEVELOPMENTAL DISABILITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANTONIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:715-897-1253
Mailing Address - Street 1:1429 TUTWILER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-4947
Mailing Address - Country:US
Mailing Address - Phone:715-897-1253
Mailing Address - Fax:
Practice Address - Street 1:1402 JONES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-3218
Practice Address - Country:US
Practice Address - Phone:715-897-1253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care