Provider Demographics
NPI:1043879331
Name:CYCLE OF LIFE CDS LLC
Entity type:Organization
Organization Name:CYCLE OF LIFE CDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RASHIDA
Authorized Official - Middle Name:TYLANA
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-323-8664
Mailing Address - Street 1:320 BROOKES DR STE 213
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2740
Mailing Address - Country:US
Mailing Address - Phone:314-323-8664
Mailing Address - Fax:314-492-8673
Practice Address - Street 1:320 BROOKES DR STE 213
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2740
Practice Address - Country:US
Practice Address - Phone:314-323-8664
Practice Address - Fax:314-492-8673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health