Provider Demographics
NPI:1386259976
Name:OPEN HANDS CONSUMER DIRECTED SERVICES, LLC
Entity type:Organization
Organization Name:OPEN HANDS CONSUMER DIRECTED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-440-4914
Mailing Address - Street 1:40 CALBREATH CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8002
Mailing Address - Country:US
Mailing Address - Phone:314-440-9414
Mailing Address - Fax:
Practice Address - Street 1:40 CALBREATH CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8002
Practice Address - Country:US
Practice Address - Phone:314-440-9414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-10
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO852954006Medicaid