Provider Demographics
NPI:1568187565
Name:B&J CONSUMER DIRECTED SERVICE, LLC
Entity Type:Organization
Organization Name:B&J CONSUMER DIRECTED SERVICE, LLC
Other - Org Name:CHOSEN PATH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-741-0955
Mailing Address - Street 1:9443 LACKLAND RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-3633
Mailing Address - Country:US
Mailing Address - Phone:314-741-0955
Mailing Address - Fax:314-741-0955
Practice Address - Street 1:9443-9445 LACKLAND RD
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-3633
Practice Address - Country:US
Practice Address - Phone:314-741-0955
Practice Address - Fax:314-741-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care