Provider Demographics
NPI:1720420383
Name:ADULT VISIONARY CONSUMER DIRECTED SERVICES, INC.
Entity Type:Organization
Organization Name:ADULT VISIONARY CONSUMER DIRECTED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-329-8707
Mailing Address - Street 1:7220 N LINDBERGH BLVD
Mailing Address - Street 2:390
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2019
Mailing Address - Country:US
Mailing Address - Phone:314-329-8707
Mailing Address - Fax:888-524-2973
Practice Address - Street 1:7220 N LINDBERGH BLVD
Practice Address - Street 2:390
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2019
Practice Address - Country:US
Practice Address - Phone:314-329-8707
Practice Address - Fax:888-524-2973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care