Provider Demographics
NPI:1275187122
Name:AXUS CONSUMER DIRECTED SERVICES LLC
Entity type:Organization
Organization Name:AXUS CONSUMER DIRECTED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:314-324-6388
Mailing Address - Street 1:4605 RICHMOND FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2848
Mailing Address - Country:US
Mailing Address - Phone:314-324-6388
Mailing Address - Fax:
Practice Address - Street 1:4605 RICHMOND FOREST DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2848
Practice Address - Country:US
Practice Address - Phone:314-324-6388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care