Provider Demographics
NPI:1942769344
Name:CONSUMER DIRECT CARE LLC
Entity type:Organization
Organization Name:CONSUMER DIRECT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GLANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-501-2505
Mailing Address - Street 1:222 ROUTE 59 STE 302
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5208
Mailing Address - Country:US
Mailing Address - Phone:314-501-2500
Mailing Address - Fax:314-501-2600
Practice Address - Street 1:111 W PORT PLZ FL 6
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3011
Practice Address - Country:US
Practice Address - Phone:314-501-2500
Practice Address - Fax:314-501-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty