1720420383 NPI number — ADULT VISIONARY CONSUMER DIRECTED SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720420383 NPI number — ADULT VISIONARY CONSUMER DIRECTED SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADULT VISIONARY CONSUMER DIRECTED SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720420383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7220 N LINDBERGH BLVD
Provider Second Line Business Mailing Address:
390
Provider Business Mailing Address City Name:
HAZELWOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63042-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-329-8707
Provider Business Mailing Address Fax Number:
888-524-2973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7220 N LINDBERGH BLVD
Provider Second Line Business Practice Location Address:
390
Provider Business Practice Location Address City Name:
HAZELWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63042-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-329-8707
Provider Business Practice Location Address Fax Number:
888-524-2973
Provider Enumeration Date:
07/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WILDER
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
314-329-8707

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com