MEDICARE: UNIQUE HEALTHCARE CDS SERVICES, 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	251E00000X	Home Health Agency		MO

General Provider Information

NPI Number	:	1932576055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIQUE HEALTHCARE CDS SERVICES, LLC

Provider Business Mailing Address
First Line	:	10430 LACKLAND RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-2202
Country	:	US
Telephone Number	:	314-428-6643
Fax Number	:

Provider Business Practice Location Address
First Line	:	10430 LACKLAND RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-2202
Country	:	US
Telephone Number	:	314-428-6643
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DEBORAH M. GANT
Credential	:
Telephone Number	:	314-428-6643

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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