MEDICARE: BEYOND CARE 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1811459340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND CARE ADULT DAYCARE LLC

Provider Business Mailing Address
First Line	:	5225 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1027
Country	:	US
Telephone Number	:	314-361-2747
Fax Number	:	314-329-3311

Provider Business Practice Location Address
First Line	:	5225 DELMAR BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1027
Country	:	US
Telephone Number	:	314-361-2747
Fax Number	:	314-329-3311

Authorized Official
Title or Position	:	OWNER
Name	:	DALLAS HOLLAND
Credential	:
Telephone Number	:	314-361-2747

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	04/03/2019

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