Provider Demographics
NPI:1720428717
Name:FIRST OPTION SERVICES
Entity Type:Organization
Organization Name:FIRST OPTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY RAINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-327-6878
Mailing Address - Street 1:928 HIGHWAY 314
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3404
Mailing Address - Country:US
Mailing Address - Phone:678-327-6878
Mailing Address - Fax:
Practice Address - Street 1:928 HIGHWAY 314
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3404
Practice Address - Country:US
Practice Address - Phone:678-327-6878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056010222320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124860AMedicaid