Provider Demographics
NPI:1467112045
Name:ADRIATIC CDS, LLC
Entity Type:Organization
Organization Name:ADRIATIC CDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEJLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKSUMIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-408-0001
Mailing Address - Street 1:4179 CRESCENT DR STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1072
Mailing Address - Country:US
Mailing Address - Phone:314-408-0001
Mailing Address - Fax:314-408-0125
Practice Address - Street 1:4179 CRESCENT DR STE A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1072
Practice Address - Country:US
Practice Address - Phone:314-408-0001
Practice Address - Fax:314-408-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care