Provider Demographics
NPI:1902028772
Name:ADVANTAGE CONSUMER DIRECTED SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANTAGE CONSUMER DIRECTED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BOSEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-282-2957
Mailing Address - Street 1:11796 WESTLINE INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3402
Mailing Address - Country:US
Mailing Address - Phone:314-282-2957
Mailing Address - Fax:314-282-2967
Practice Address - Street 1:11796 WESTLINE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3402
Practice Address - Country:US
Practice Address - Phone:314-282-2957
Practice Address - Fax:314-282-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0008753Medicaid
MO266270008Medicaid
MO286270004Medicaid