1548537590 NPI number — ALTERNATIVE CHOICES CONSUMER DIRECTED SVC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548537590 NPI number — ALTERNATIVE CHOICES CONSUMER DIRECTED SVC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTERNATIVE CHOICES CONSUMER DIRECTED SVC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548537590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 GREEN VALLEY DR
Provider Second Line Business Mailing Address:
1920 GREEN VALLEY DRIVE
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63136-3205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-761-3838
Provider Business Mailing Address Fax Number:
314-869-3393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 GREEN VALLEY DR
Provider Second Line Business Practice Location Address:
1920 GREEN VALLEY DRIVE
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-761-3838
Provider Business Practice Location Address Fax Number:
314-869-3393
Provider Enumeration Date:
11/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PENNINGTON
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
LAKALE
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
314-761-3838

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  B00436508 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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