Provider Demographics
NPI:1295275626
Name:FIRST MIDWEST CONSUMER DIRECTED SERVICES LLC
Entity type:Organization
Organization Name:FIRST MIDWEST CONSUMER DIRECTED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:314-677-0394
Mailing Address - Street 1:7733 FORSYTH BLVD FL 11
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1878
Mailing Address - Country:US
Mailing Address - Phone:314-296-6199
Mailing Address - Fax:314-754-9591
Practice Address - Street 1:7733 FORSYTH BLVD FL 11
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1878
Practice Address - Country:US
Practice Address - Phone:314-296-6199
Practice Address - Fax:314-754-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-04
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care