MEDICARE: CHOICE COMMUNITY CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	1010231	IL

General Provider Information

NPI Number	:	1487779195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE COMMUNITY CARE, INC.

Provider Business Mailing Address
First Line	:	519 WASHINGTON PL
Second Line	:	1ST FLOOR
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62205-2039
Country	:	US
Telephone Number	:	618-271-7500
Fax Number	:	618-271-7544

Provider Business Practice Location Address
First Line	:	519 WASHINGTON PL
Second Line	:	1ST FLOOR
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62205-2039
Country	:	US
Telephone Number	:	618-271-7500
Fax Number	:	618-271-7544

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS LOYS JEAN MOORE
Credential	:
Telephone Number	:	618-271-7500

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	08/22/2020

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