MEDICARE: CDE CONSUMER DIRECTED SERVICES 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1922439553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDE CONSUMER DIRECTED SERVICES INC

Provider Business Mailing Address
First Line	:	8770 N BROADWAY STE 2
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63147-2225
Country	:	US
Telephone Number	:	314-868-1509
Fax Number	:	314-868-6683

Provider Business Practice Location Address
First Line	:	8770 N BROADWAY STE 2
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63147-2225
Country	:	US
Telephone Number	:	314-868-1509
Fax Number	:	314-868-6683

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MRS. CAROLYN ERBY
Credential	:
Telephone Number	:	314-868-0185

Provider Enumeration Date	:	12/08/2013
Last Update Date	:	12/08/2013

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