Healthcare Provider Details

I. General information

NPI: 1740669373
Provider Name (Legal Business Name): VICTOR'S HOME CARE CDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 DELMAR BLVD, STE 507
ST. LOUIS MO
63124
US

IV. Provider business mailing address

8420 DELMAR BLVD, STE 507
ST. LOUIS MO
63124
US

V. Phone/Fax

Practice location:
  • Phone: 314-872-8844
  • Fax: 314-872-8854
Mailing address:
  • Phone: 314-872-8844
  • Fax: 314-872-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number001448674
License Number StateMO

VIII. Authorized Official

Name: YELENA DAVYDENKO
Title or Position: OWNER
Credential:
Phone: 314-872-8844