MEDICARE: DAISYZ ADULT DAYCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1205218120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAISYZ ADULT DAYCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 460563
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10262 PAGE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-1322
Country	:	US
Telephone Number	:	314-401-5571
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NATOSHA SNOWDEN
Credential	:
Telephone Number	:	314-401-5571

Provider Enumeration Date	:	06/27/2015
Last Update Date	:	06/27/2015

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