Healthcare Provider Details

I. General information

NPI: 1902028772
Provider Name (Legal Business Name): ADVANTAGE CONSUMER DIRECTED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11796 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3402
US

IV. Provider business mailing address

11796 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3402
US

V. Phone/Fax

Practice location:
  • Phone: 314-282-2957
  • Fax: 314-282-2967
Mailing address:
  • Phone: 314-282-2957
  • Fax: 314-282-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BOSEN P JOHN
Title or Position: CEO
Credential:
Phone: 314-282-2957