Provider Demographics
NPI:1720642861
Name:FIRST CHOICE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:FIRST CHOICE BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-929-4793
Mailing Address - Street 1:17 WARREN RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5001
Mailing Address - Country:US
Mailing Address - Phone:410-929-4793
Mailing Address - Fax:
Practice Address - Street 1:600 REISTERSTOWN RD STE 402
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5107
Practice Address - Country:US
Practice Address - Phone:410-929-4793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD479305600Medicaid