Healthcare Provider Details

I. General information

NPI: 1952432478
Provider Name (Legal Business Name): CDE HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 N BROADWAY
SAINT LOUIS MO
63147-2225
US

IV. Provider business mailing address

8770 N BROADWAY
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 TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number251E00000X
License Number StateMO

VIII. Authorized Official

Name: MRS. MARICIA R LAWSON
Title or Position: GENERAL MANAGER
Credential:
Phone: 314-868-1509