Provider Demographics
NPI:1609287309
Name:PERSONALIZED CARE, CONSUMER DIRECT SERVICES, LC
Entity Type:Organization
Organization Name:PERSONALIZED CARE, CONSUMER DIRECT SERVICES, LC
Other - Org Name:PERSONALIZED CARE, CDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-507-3928
Mailing Address - Street 1:3238 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-3733
Mailing Address - Country:US
Mailing Address - Phone:770-559-7474
Mailing Address - Fax:314-741-4836
Practice Address - Street 1:3238 PARKER RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3733
Practice Address - Country:US
Practice Address - Phone:770-559-7474
Practice Address - Fax:314-741-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health