Provider Demographics
NPI:1053918557
Name:POLK CONSUMER DIRECTED SERVICES LLC
Entity type:Organization
Organization Name:POLK CONSUMER DIRECTED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RIKKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-517-7192
Mailing Address - Street 1:3430 MCKELVEY RD STE L
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2556
Mailing Address - Country:US
Mailing Address - Phone:314-517-7192
Mailing Address - Fax:314-985-5833
Practice Address - Street 1:3430 MCKELVEY RD STE L
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2556
Practice Address - Country:US
Practice Address - Phone:314-517-7192
Practice Address - Fax:314-985-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health