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Polk Consumer Directed Services Llc

NPI Registration Record

Provider / OrganizationNPIDate Certified
POLK CONSUMER DIRECTED SERVICES LLC10539185572020-10-11
Entity TypeOrganization
Provider OrganizationPOLK CONSUMER DIRECTED SERVICES LLC
Practice Office Address3430 MCKELVEY RD STE L
BRIDGETON, MO US
Practice Office Telephone3145177192
Practice Office Fax3149855833
Mailing Address3430 MCKELVEY RD STE L
BRIDGETON, MO 630442556 US
Business Telephone3145177192
Business Fax3149855833
Authorized OfficialRIKKISHA POLK, OWNER/DIRECTOR
3145177192
HPT Codes
CodeLicense NoState
251E00000X
253Z00000X PRIMARY
OPI Codes
Governmental Registrations [CAGE/NCAGE/DUNS]

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