Provider Demographics
NPI:1316240955
Name:FIRST CHOICE IN HOME CARE
Entity type:Organization
Organization Name:FIRST CHOICE IN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:II
Authorized Official - Credentials:N/A
Authorized Official - Phone:928-607-8834
Mailing Address - Street 1:3321 S MOORE CIR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-8501
Mailing Address - Country:US
Mailing Address - Phone:928-607-8834
Mailing Address - Fax:
Practice Address - Street 1:3321 SOUTH MOORE CIRCLE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-607-8834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ302F00000X302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization