Provider Demographics
NPI:1205365202
Name:A FAITHFUL CARE CONSUMER DIRECTED SERVICES, LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:A FAITHFUL CARE CONSUMER DIRECTED SERVICES, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-656-1495
Mailing Address - Street 1:7220 N LINDBERGH BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2019
Mailing Address - Country:US
Mailing Address - Phone:314-656-1495
Mailing Address - Fax:314-656-1547
Practice Address - Street 1:7220 N LINDBERGH BLVD STE 20
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2019
Practice Address - Country:US
Practice Address - Phone:314-656-1495
Practice Address - Fax:314-656-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health