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General NPI Number Information
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NPI Number | 1912246646
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Entity Type | Organization
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Legal Business Name | JE CONSUMER DIRECTED SERVICE LLC
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 10270 A PAGE AVENUE
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City | SAINT LOUIS
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State | MO
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Zip | 63132
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Country | US
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Telephone | 314-497-3948
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28484
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City | SAINT LOUIS
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State | MO
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Zip | 63146
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Country | US
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Telephone | 314-497-3948
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MRS. NATOSHA SNOWDEN-GOMILLER
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Credential |
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Telephone | 314-497-3948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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