Provider Demographics
NPI:1487779195
Name:CHOICE COMMUNITY CARE, INC.
Entity type:Organization
Organization Name:CHOICE COMMUNITY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LOYS
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-271-7500
Mailing Address - Street 1:519 WASHINGTON PL
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62205-2039
Mailing Address - Country:US
Mailing Address - Phone:618-271-7500
Mailing Address - Fax:618-271-7544
Practice Address - Street 1:519 WASHINGTON PL
Practice Address - Street 2:1ST FLOOR
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62205-2039
Practice Address - Country:US
Practice Address - Phone:618-271-7500
Practice Address - Fax:618-271-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010231314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid