Provider Demographics
NPI:1770766891
Name:1ST CHOICE THERAPEUTICS, LLC
Entity type:Organization
Organization Name:1ST CHOICE THERAPEUTICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-587-4700
Mailing Address - Street 1:231 NORTHERN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9189
Mailing Address - Country:US
Mailing Address - Phone:570-587-4700
Mailing Address - Fax:
Practice Address - Street 1:231 NORTHERN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9189
Practice Address - Country:US
Practice Address - Phone:570-587-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BP3500X
PA16843601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024949780001Medicaid