Provider Demographics
NPI:1174076343
Name:A DIFFERENT WORLD CONSUMER DIRECT SERVICES LLC
Entity type:Organization
Organization Name:A DIFFERENT WORLD CONSUMER DIRECT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANYELLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-482-7065
Mailing Address - Street 1:111 CHURCH ST
Mailing Address - Street 2:SUITE 104-105
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135
Mailing Address - Country:US
Mailing Address - Phone:314-736-1388
Mailing Address - Fax:
Practice Address - Street 1:111 CHURCH ST
Practice Address - Street 2:SUITE 104-105
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2441
Practice Address - Country:US
Practice Address - Phone:314-736-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health