Provider Demographics
NPI:1548537590
Name:ALTERNATIVE CHOICES CONSUMER DIRECTED SVC LLC
Entity type:Organization
Organization Name:ALTERNATIVE CHOICES CONSUMER DIRECTED SVC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:LAKALE
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOCIATE DEGREE
Authorized Official - Phone:314-761-3838
Mailing Address - Street 1:1920 GREEN VALLEY DR
Mailing Address - Street 2:1920 GREEN VALLEY DRIVE
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-3205
Mailing Address - Country:US
Mailing Address - Phone:314-761-3838
Mailing Address - Fax:314-869-3393
Practice Address - Street 1:1920 GREEN VALLEY DR
Practice Address - Street 2:1920 GREEN VALLEY DRIVE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-3205
Practice Address - Country:US
Practice Address - Phone:314-761-3838
Practice Address - Fax:314-869-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOB00436508251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health