Provider Demographics
NPI:1922369453
Name:EXTRACARE CDS SERVICES,INC
Entity Type:Organization
Organization Name:EXTRACARE CDS SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-432-2439
Mailing Address - Street 1:8420 DELMAR BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2179
Mailing Address - Country:US
Mailing Address - Phone:314-432-2439
Mailing Address - Fax:314-432-2745
Practice Address - Street 1:8420 DELMAR BLVD STE 405
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2179
Practice Address - Country:US
Practice Address - Phone:314-432-2439
Practice Address - Fax:314-432-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health