Healthcare Provider Details

I. General information

NPI: 1811459340
Provider Name (Legal Business Name): BEYOND CARE ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 DELMAR BLVD
SAINT LOUIS MO
63108-1027
US

IV. Provider business mailing address

5225 DELMAR BLVD
SAINT LOUIS MO
63108-1027
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-2747
  • Fax: 314-329-3311
Mailing address:
  • Phone: 314-361-2747
  • Fax: 314-329-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DALLAS HOLLAND
Title or Position: OWNER
Credential:
Phone: 314-361-2747