Provider Demographics
NPI:1194912659
Name:A-1 COMMUNITY CHOICE
Entity type:Organization
Organization Name:A-1 COMMUNITY CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCKLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-269-8563
Mailing Address - Street 1:350 N WASHINGTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-5806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 N WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-5806
Practice Address - Country:US
Practice Address - Phone:321-269-8563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691342396Medicaid
FL691342396Medicaid