Provider Demographics
NPI:1851844567
Name:TKB HOME CARE CDS LLC
Entity Type:Organization
Organization Name:TKB HOME CARE CDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-839-1210
Mailing Address - Street 1:580 N HIGHWAY 67 ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-5130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:580 N HIGHWAY 67 ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-5130
Practice Address - Country:US
Practice Address - Phone:314-839-1210
Practice Address - Fax:314-831-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0016619Medicaid