Provider Demographics
NPI:1639515513
Name:OVERFLOW CONSUMER DIRECTED SERVICES
Entity Type:Organization
Organization Name:OVERFLOW CONSUMER DIRECTED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERREE
Authorized Official - Middle Name:SHELONDIA
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-276-8695
Mailing Address - Street 1:1600 HERITAGE LNDG
Mailing Address - Street 2:SUITE 212-C
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303-8489
Mailing Address - Country:US
Mailing Address - Phone:314-276-8695
Mailing Address - Fax:314-428-3577
Practice Address - Street 1:1600 HERITAGE LNDG
Practice Address - Street 2:SUITE 212-C
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-8489
Practice Address - Country:US
Practice Address - Phone:314-276-8695
Practice Address - Fax:314-428-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10103251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health