Provider Demographics
NPI:1740669373
Name:VICTOR'S HOME CARE CDS, LLC
Entity type:Organization
Organization Name:VICTOR'S HOME CARE CDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVYDENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-872-8844
Mailing Address - Street 1:8420 DELMAR BLVD, STE 507
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124
Mailing Address - Country:US
Mailing Address - Phone:314-872-8844
Mailing Address - Fax:314-872-8854
Practice Address - Street 1:8420 DELMAR BLVD, STE 507
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124
Practice Address - Country:US
Practice Address - Phone:314-872-8844
Practice Address - Fax:314-872-8854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001448674251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based