Provider Demographics
NPI:1629823471
Name:FIRST CHOICE ELDERCARE LLC
Entity type:Organization
Organization Name:FIRST CHOICE ELDERCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:MANTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-574-9773
Mailing Address - Street 1:1654 HONDELEAU LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7696
Mailing Address - Country:US
Mailing Address - Phone:801-574-9773
Mailing Address - Fax:971-252-7319
Practice Address - Street 1:170 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-1306
Practice Address - Country:US
Practice Address - Phone:541-621-1469
Practice Address - Fax:971-252-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care