Provider Demographics
NPI:1104379114
Name:GOOD FAITH CONSUMER DIRECTED SERVICES LLC
Entity Type:Organization
Organization Name:GOOD FAITH CONSUMER DIRECTED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-749-0152
Mailing Address - Street 1:3310 MERAMEC ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-4311
Mailing Address - Country:US
Mailing Address - Phone:314-749-0152
Mailing Address - Fax:844-316-0208
Practice Address - Street 1:3310 MERAMEC ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4311
Practice Address - Country:US
Practice Address - Phone:314-749-0152
Practice Address - Fax:844-316-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC9814754251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health