Provider Demographics
NPI:1003383134
Name:ASSURANCE CONSUMER DIRECTED SERVICES
Entity Type:Organization
Organization Name:ASSURANCE CONSUMER DIRECTED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:REKENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-562-5294
Mailing Address - Street 1:3070 KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6220
Mailing Address - Country:US
Mailing Address - Phone:314-733-5420
Mailing Address - Fax:314-733-5421
Practice Address - Street 1:3070 KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6220
Practice Address - Country:US
Practice Address - Phone:314-733-5420
Practice Address - Fax:314-733-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health