Provider Demographics
NPI:1881050862
Name:1ST CHOICE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:1ST CHOICE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHIPPY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-990-7176
Mailing Address - Street 1:405 PARKER IVEY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6513
Mailing Address - Country:US
Mailing Address - Phone:864-990-7176
Mailing Address - Fax:800-418-7133
Practice Address - Street 1:405 PARKER IVEY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6513
Practice Address - Country:US
Practice Address - Phone:864-990-7176
Practice Address - Fax:800-418-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302782Medicaid