Healthcare Provider Details

I. General information

NPI: 1316128424
Provider Name (Legal Business Name): WHITE & ASSOCIATES CONSUMER DIRECTED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 TRUMAN BLVD
CARUTHERSVILLE MO
63830-2444
US

IV. Provider business mailing address

PO BOX 902
CARUTHERSVILLE MO
63830-0902
US

V. Phone/Fax

Practice location:
  • Phone: 573-333-0084
  • Fax:
Mailing address:
  • Phone: 573-333-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. JARRED YATES
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-333-0084