Organization
FIRST CHOICE HEALTH CENTERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON MARIE GORNEAULT (BILLING MANAGER)
(860) 610-6124
Entity
Organization
Contact information
Practice address
150 N MAIN ST STE 230, MANCHESTER, CT 06042-2086
(860) 528-1359
(860) 528-5180
Mailing address
94 CONNECTICUT BLVD, EAST HARTFORD, CT 06108-3013
(860) 528-1359
(860) 528-5180
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
0784
CT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236164
—
CT
Enumeration date
06/08/2018
Last updated
06/08/2018
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