Healthcare Provider Details

I. General information

NPI: 1578843462
Provider Name (Legal Business Name): WILLIAMS CONSUMERS DIRECTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S FLORISSANT ROAD
SAINT LOUIS MO
63135-2984
US

IV. Provider business mailing address

716 S FLORISSANT ROAD
SAINT LOUIS MO
63135-2984
US

V. Phone/Fax

Practice location:
  • Phone: 314-522-6414
  • Fax: 314-522-1934
Mailing address:
  • Phone: 314-522-6414
  • Fax: 314-522-1934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ANNIE JEAN WILLIAMS I
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-229-8289