Provider Demographics
NPI:1144653718
Name:TRUCARE CONSUMER DIRECTED SERVICES
Entity type:Organization
Organization Name:TRUCARE CONSUMER DIRECTED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-322-9281
Mailing Address - Street 1:13950 DAVEY DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2514
Mailing Address - Country:US
Mailing Address - Phone:314-716-3064
Mailing Address - Fax:314-716-3116
Practice Address - Street 1:13950 DAVEY DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2514
Practice Address - Country:US
Practice Address - Phone:314-716-3064
Practice Address - Fax:314-716-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care