Provider Demographics
NPI:1780124511
Name:PRIORITY CONSUMER DIRECTED SERVICES LLC
Entity type:Organization
Organization Name:PRIORITY CONSUMER DIRECTED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:314-753-5920
Mailing Address - Street 1:1409 WASHINTONG AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103
Mailing Address - Country:US
Mailing Address - Phone:314-315-4950
Mailing Address - Fax:314-254-8550
Practice Address - Street 1:1409 WASHINTONG AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103
Practice Address - Country:US
Practice Address - Phone:314-315-4950
Practice Address - Fax:314-254-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health