Provider Demographics
NPI:1962884395
Name:FIRST CHOICE HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:FIRST CHOICE HEALTH CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARKET
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:860-610-6131
Mailing Address - Street 1:94 CONNECTICUT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-610-6131
Mailing Address - Fax:860-290-4142
Practice Address - Street 1:444 CENTER ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3926
Practice Address - Country:US
Practice Address - Phone:860-610-6131
Practice Address - Fax:860-290-4142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CHOICE HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-22
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0816261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236164Medicaid