Healthcare Provider Details

I. General information

NPI: 1316677917
Provider Name (Legal Business Name): CDS OF SAINT LOUIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 DOUGHERTY FERRY RD STE 200
SAINT LOUIS MO
63122-3372
US

IV. Provider business mailing address

2705 DOUGHERTY FERRY RD STE 200
SAINT LOUIS MO
63122-3372
US

V. Phone/Fax

Practice location:
  • Phone: 314-858-9093
  • Fax:
Mailing address:
  • Phone: 314-858-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEKAL PATEL
Title or Position: MEMBER
Credential:
Phone: 469-275-1075