MEDICARE: BEYOND NURSING CARE 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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1477228609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND NURSING CARE LLC

Provider Business Mailing Address
First Line	:	2055 CRAIGSHIRE RD STE 420F
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4043
Country	:	US
Telephone Number	:	314-548-6159
Fax Number	:	314-887-7004

Provider Business Practice Location Address
First Line	:	2055 CRAIGSHIRE RD STE 420F
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4043
Country	:	US
Telephone Number	:	816-400-4276
Fax Number	:	314-887-7004

Authorized Official
Title or Position	:	SENIOR COMMUNITY HOME CARE
Name	:	MISS BOBIE S CALICUTT
Credential	:	CNA CMT
Telephone Number	:	314-536-2930

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	09/27/2021

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