BLACK CREEK SUPPORTS AND SERVICES, INC. (NPI# 1902214174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902214174 |
| Entity Type | Organization |
| Organization Name | BLACK CREEK SUPPORTS AND SERVICES, INC. |
| Practice Address |
1700 Lismore Ct Middleburg FL 32068-6703 |
| Practice Telephone | 9044492699 |
| Practice Fax Number | 9043752019 |
| Mailing Telephone | 9044492699 |
| Mailing Fax Number | 9043752019 |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2014-07-31 |
| Authorized Official Name | SHIELA BRYANT BUTLER (PRESIDENT) |
| Authorized Official Telephone | 9044492699 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 253Z00000X | In Home Supportive Care | 232967 | FL | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 008143400 | 05 |
| Street Address |
1700 LISMORE CT |
| City | MIDDLEBURG |
| State | FL |
| Zip Code | 32068-6703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073084174 | Christopher Littles | Technician | 3122 Angora Bay Dr, Middleburg, FL 32068 | 2018-12-16 |
| 1730685157 | Children's Express Care Clinic | Pediatrics | 430 College Drive, Suite 100-102, Middleburg, FL 32068 | 2018-04-04 |
| 1588162762 | Lp Sw Jacksonville, LLC | Skilled Nursing Facility | 1280 Henley Road, Middleburg, FL 32068 | 2018-01-23 |
| 1396264982 | Michael Jessie Visita Roberts | Physical Therapy Assistant | 1648 St. Vincents Way, 100b, Middleburg, FL 32068 | 2017-09-14 |
| 1093239915 | Kevia Hart | In Home Supportive Care | 2718 Tina Lane, Middleburg, FL 32068 | 2017-08-02 |
| 1366899825 | Serena Burr | Midwife | 1986 Friendly Pl, Middleburg, FL 32068 | 2016-05-15 |
| 1932573672 | Jamie Dietrich | Physical Therapist | 2583-3 County Road 220, Middleburg, FL 32068 | 2015-11-18 |
| 1154791614 | Katherine Wenger | Physical Therapist | 2580-3 Country Road 220, Suite 3, Middleburg, FL 32068 | 2015-09-28 |
| 1699024240 | Amanda Copeland | Speech-Language Pathologist | 2823 Woodstone Dr., Middleburg, FL 32068 | 2012-08-29 |
| 1194089243 | Good Samaritan Home Companion Services, Inc. | In Home Supportive Care | 3689 Main Street, Middleburg, FL 32068 | 2012-07-03 |
| Find all providers in zip 32068 | ||||
| Taxonomy Code | 253Z00000X |
| Grouping | Agencies |
| Classification | In Home Supportive Care |
| An In Home Supportive Care Agency provides services in the patient’s home with the goal of enabling the patient to remain at home. The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598362675 | Kevin Parks | In Home Supportive Care | 10388 North Street, Middleburg, OH 43336 | 2020-10-02 |
| 1700494234 | Sdx Home Care Operations, LLC | In Home Supportive Care | 2755 Blanding Blvd Ste B, Middleburg, FL 32068-5612 | 2020-07-21 |
| 1093239915 | Kevia Hart | In Home Supportive Care | 2718 Tina Lane, Middleburg, FL 32068 | 2017-08-02 |
| 1194089243 | Good Samaritan Home Companion Services, Inc. | In Home Supportive Care | 3689 Main Street, Middleburg, FL 32068 | 2012-07-03 |
| 1417235771 | Pca Plus Inc | In Home Supportive Care | 419-a College Dr., Suite 6, Middleburg, FL 32068 | 2011-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700487477 | Benevolent Home Care Solutions, LLC | In Home Supportive Care | 303 N Charles Willis Dr, Midway, FL 32343-4294 | 2020-11-08 |
| 1396346045 | Alea Home Services Corp | In Home Supportive Care | 10300 Sw 72nd St Ste 261a, Miami, FL 33173-3014 | 2020-11-07 |
| 1124629134 | Shameka Ashawn Raines | In Home Supportive Care | 111 N Bay St, Port St Joe, FL 32456-1431 | 2020-11-05 |
| 1477154680 | C.n.e Health Care LLC | In Home Supportive Care | 10859 Jessica Ash Dr, Jacksonville, FL 32218-6537 | 2020-11-04 |
| 1487254199 | Ahhc Services, LLC | In Home Supportive Care | 2650 Ne 57th St, Ft Lauderdale, FL 33308-2709 | 2020-10-30 |
| 1821698648 | Evolution Home Care LLC | In Home Supportive Care | 7401 Wiles Rd Ste 214, Coral Springs, FL 33067-2038 | 2020-10-30 |
| 1790385334 | Care One, LLC | In Home Supportive Care | 15399 Ne 6th Ave Apt 401, Miami, FL 33162-5076 | 2020-10-30 |
| 1861092801 | Laundry Cleaner Corp | In Home Supportive Care | 7050 Nw 2nd Ave, Miami, FL 33150-4008 | 2020-10-29 |
| 1295334258 | Petagaye A Porter | In Home Supportive Care | 1627 Burnham St, Orlando, FL 32808-6011 | 2020-10-21 |
| 1942809918 | Angel Heart Homemaker and Companion Care Services LLC | In Home Supportive Care | 1423 Se 16th Pl Ste 203, Cape Coral, FL 33990-3891 | 2020-10-21 |
| Find all providers with the same taxonomy | ||||
| City | MIDDLEBURG |
| Zip Code | 32068 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.