Provider Demographics
NPI:1588899124
Name:FIRST COMMUNITY CARE, LLC
Entity type:Organization
Organization Name:FIRST COMMUNITY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-568-2236
Mailing Address - Street 1:3351 S SIXTH ST.
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-4776
Mailing Address - Country:US
Mailing Address - Phone:866-696-1637
Mailing Address - Fax:989-839-2970
Practice Address - Street 1:3351 S 6TH STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4776
Practice Address - Country:US
Practice Address - Phone:866-696-1637
Practice Address - Fax:989-839-2970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-27
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5332030001Medicare NSC