Provider Demographics
NPI:1720623077
Name:FIRST CHOICE GROUP HOME INC
Entity Type:Organization
Organization Name:FIRST CHOICE GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-541-4691
Mailing Address - Street 1:750 SW 108TH AVE # 35-307
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7126
Mailing Address - Country:US
Mailing Address - Phone:786-541-4691
Mailing Address - Fax:
Practice Address - Street 1:750 SW 108TH AVE # 35-307
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-7126
Practice Address - Country:US
Practice Address - Phone:786-541-4691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-11
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services