MEDICARE: AMG UNITY CDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1285120584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMG UNITY CDS, LLC

Provider Business Mailing Address
First Line	:	11754 LUSHER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-1103
Country	:	US
Telephone Number	:	314-629-2658
Fax Number	:

Provider Business Practice Location Address
First Line	:	11754 LUSHER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-1103
Country	:	US
Telephone Number	:	314-629-2658
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MRS. MYRA MONROE
Credential	:
Telephone Number	:	314-629-2658

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	07/10/2018

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