Provider Demographics
NPI:1942889605
Name:UNITED CONSUMER DIRECTED SERVICES LLC
Entity Type:Organization
Organization Name:UNITED CONSUMER DIRECTED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMMESHRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-755-9653
Mailing Address - Street 1:6173 LAKE PADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-4720
Mailing Address - Country:US
Mailing Address - Phone:314-755-9653
Mailing Address - Fax:800-853-6643
Practice Address - Street 1:6173 LAKE PADDOCK DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-4720
Practice Address - Country:US
Practice Address - Phone:314-755-9653
Practice Address - Fax:800-853-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MONONEMedicaid