Provider Demographics
NPI:1336385699
Name:1ST CHOICE PROFESSIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:1ST CHOICE PROFESSIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-737-5897
Mailing Address - Street 1:10532 GREEN HEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1541
Mailing Address - Country:US
Mailing Address - Phone:704-737-5897
Mailing Address - Fax:336-884-1519
Practice Address - Street 1:10532 GREEN HEDGE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1541
Practice Address - Country:US
Practice Address - Phone:704-737-5897
Practice Address - Fax:336-884-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children