Provider Demographics
NPI:1508290461
Name:BLEST ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:BLEST ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:KAMANDA
Authorized Official - Last Name:GAKURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-293-6223
Mailing Address - Street 1:500 GREENWAY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031
Mailing Address - Country:US
Mailing Address - Phone:314-838-4707
Mailing Address - Fax:314-838-4707
Practice Address - Street 1:500 GREENWAY MANOR DRIVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033
Practice Address - Country:US
Practice Address - Phone:314-838-4707
Practice Address - Fax:314-838-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care