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NPI Code Detail

MEDICARE: SUPPORTIVE LIVING CONSUMER DIRECT

MEDICARE: SUPPORTIVE LIVING CONSUMER DIRECT
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1376784280
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPPORTIVE LIVING CONSUMER DIRECT
Provider Business Mailing Address
First Line : 4015 SEVEN HILLS DR
Second Line :
City : FLORISSANT
State : MO
Zip : 63033-6737
Country : US
Telephone Number : 314-215-9448
Fax Number :
Provider Business Practice Location Address
First Line : 4015 SEVEN HILLS DR
Second Line :
City : FLORISSANT
State : MO
Zip : 63033-6737
Country : US
Telephone Number : 314-215-9448
Fax Number :
Authorized Official
Title or Position : OWER
Name : LACHELLE CHANEY
Credential :
Telephone Number : 314-215-9448
Provider Enumeration Date : 03/23/2009
Last Update Date : 03/23/2009

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Directions to “SUPPORTIVE LIVING CONSUMER DIRECT ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.