=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548537590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALTERNATIVE CHOICES CONSUMER DIRECTED SVC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2011
-----------------------------------------------------
Last Update Date | 05/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1920 GREEN VALLEY DR 1920 GREEN VALLEY DRIVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63136-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-761-3838
-----------------------------------------------------
Fax | 314-869-3393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1920 GREEN VALLEY DR 1920 GREEN VALLEY DRIVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63136-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-761-3838
-----------------------------------------------------
Fax | 314-869-3393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MS. JACQUELINE LAKALE PENNINGTON
-----------------------------------------------------
Credential | ASSOCIATE DEGREE
-----------------------------------------------------
Telephone | 314-761-3838
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | B00436508
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------