Provider Demographics
NPI:1780151340
Name:SENIOR SOURCE CDS LLC
Entity type:Organization
Organization Name:SENIOR SOURCE CDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAMIKKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-709-3976
Mailing Address - Street 1:7733 FORSYTH BLVD STE 1106
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1817
Mailing Address - Country:US
Mailing Address - Phone:314-296-6005
Mailing Address - Fax:855-940-0173
Practice Address - Street 1:7733 FORSYTH BLVD STE 1106
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1817
Practice Address - Country:US
Practice Address - Phone:314-296-6005
Practice Address - Fax:855-940-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty