NPIMap

Organization Active NPI

Diversified Support Services, LLC

  • Respite Care
  • Saint Louis, MO
National Provider Identifier
1821540212
Registry record updated Nov 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
License
LC001486661 Issued in MO
Legal business name
DIVERSIFIED SUPPORT SERVICES, LLC
Practice address
3910 Kingsland CT
# 2F
Saint Louis, MO 63116-4432
Phone
(314) 297-8656
Fax
(314) 297-8656
NPI assigned
Nov 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angie M Wyatt
Title
Owner
Phone
(314) 297-8656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Respite Care 385H00000X LC001486661 MO Primary

Addresses

Primary practice location

3910 Kingsland CT
# 2F
Saint Louis, MO 63116-4432

Mailing address

3910 Kingsland CT
# 2F
Saint Louis, MO 63116-4432

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1821540212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 KINGSLAND CT",
            "address_2": "# 2F",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631164432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 KINGSLAND CT",
            "address_2": "# 2F",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631164432",
            "telephone_number": "314-297-8656",
            "fax_number": "314-297-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-01",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-297-8656"
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "MO",
            "license": "LC001486661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.