=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871935494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL ACCESS CDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2013
-----------------------------------------------------
Last Update Date | 07/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 N 17TH ST STE 102
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63103-2336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-669-9819
-----------------------------------------------------
Fax | 314-669-9856
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 N 17TH ST STE 102
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63103-2336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-669-9819
-----------------------------------------------------
Fax | 314-669-9856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AARON SNOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-669-9819
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------