Healthcare Provider Details

I. General information

NPI: 1922439553
Provider Name (Legal Business Name): CDE CONSUMER DIRECTED SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2013
Last Update Date: 12/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 N BROADWAY STE 2
SAINT LOUIS MO
63147-2225
US

IV. Provider business mailing address

8770 N BROADWAY STE 2
SAINT LOUIS MO
63147-2225
US

V. Phone/Fax

Practice location:
  • Phone: 314-868-1509
  • Fax: 314-868-6683
Mailing address:
  • Phone: 314-868-1509
  • Fax: 314-868-6683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROLYN ERBY
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 314-868-0185