Black Creek Supports and Services, Inc.

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

232967 Issued in FL

Legal business name

BLACK CREEK SUPPORTS AND SERVICES, INC.

Practice address

1700 Lismore CT
Middleburg, FL 32068-6703

Phone

(904) 449-2699

Fax

(904) 375-2019

NPI assigned

Jul 31, 2014

Last updated

Jul 31, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shiela Bryant Butler

Title

President

Phone

(904) 449-2699

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406764800000",
    "number": "1902214174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 LISMORE CT",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320686703",
            "telephone_number": "904-449-2699",
            "fax_number": "904-375-2019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 LISMORE CT",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320686703",
            "telephone_number": "904-449-2699",
            "fax_number": "904-375-2019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK CREEK SUPPORTS AND SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2014-07-31",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "SHIELA",
        "authorized_official_middle_name": "BRYANT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-449-2699"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "FL",
            "license": "232967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008143400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Judith Booth, LMHC

• In Home Supportive Care Agency in Middleburg, FL
• Providers in Middleburg, FL by specialty
• In Home Supportive Care Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.