Provider Demographics
NPI:1942769344
Name:CONSUMER DIRECT CARE LLC
Entity Type:Organization
Organization Name:CONSUMER DIRECT CARE LLC
Other - Org Name:DELUXE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YEDE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-500-3621
Mailing Address - Street 1:3430 MCKELVEY RD STE J
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2556
Mailing Address - Country:US
Mailing Address - Phone:314-501-2500
Mailing Address - Fax:
Practice Address - Street 1:3430 MCKELVEY RD STE J
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2556
Practice Address - Country:US
Practice Address - Phone:314-501-2500
Practice Address - Fax:314-501-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty