MEDICARE: UNITED CONSUMER DIRECTED SERVICES LLC

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
2	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942889605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED CONSUMER DIRECTED SERVICES LLC

Provider Business Mailing Address
First Line	:	6173 LAKE PADDOCK DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-4720
Country	:	US
Telephone Number	:	314-755-9653
Fax Number	:	800-853-6643

Provider Business Practice Location Address
First Line	:	6173 LAKE PADDOCK DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-4720
Country	:	US
Telephone Number	:	314-755-9653
Fax Number	:	800-853-6643

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	KIMMESHRANDA FIELDS
Credential	:
Telephone Number	:	314-755-9653

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	04/07/2021

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Directions to “UNITED CONSUMER DIRECTED SERVICES LLC ” Practice Location

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