Provider Demographics
NPI:1467215301
Name:CCFE LLC
Entity Type:Organization
Organization Name:CCFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-626-3905
Mailing Address - Street 1:10097 MANCHESTER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1828
Mailing Address - Country:US
Mailing Address - Phone:314-626-3905
Mailing Address - Fax:314-626-3931
Practice Address - Street 1:10097 MANCHESTER RD STE 208
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-1828
Practice Address - Country:US
Practice Address - Phone:314-626-3905
Practice Address - Fax:314-626-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care