Organization
BLACK CREEK SUPPORTS AND SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIELA BRYANT BUTLER (PRESIDENT)
(904) 449-2699
Entity
Organization
Contact information
Practice address
1700 LISMORE CT, MIDDLEBURG, FL 32068-6703
(904) 449-2699
(904) 375-2019
Mailing address
1700 LISMORE CT, MIDDLEBURG, FL 32068-6703
(904) 449-2699
(904) 375-2019
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
232967
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008143400
—
FL
Enumeration date
07/31/2014
Last updated
07/31/2014
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