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General NPI Number Information
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NPI Number | 1568187565
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Entity Type | Organization
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Legal Business Name | B&J CONSUMER DIRECTED SERVICE, LLC
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 9443-9445 LACKLAND RD
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City | OVERLAND
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State | MO
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Zip | 63114-3633
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Country | US
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Telephone | 314-741-0955
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Fax | 314-741-0955
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Provider Business Mailing Address
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Address Line | 9443 LACKLAND RD
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City | OVERLAND
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State | MO
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Zip | 63114-3633
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Country | US
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Telephone | 314-741-0955
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Fax | 314-741-0955
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRYAN WILLIAMS
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Credential |
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Telephone | 314-741-0955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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