MEDICARE: AWESOME STEP DEVELOPMENT

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	251E00000X	Home Health Agency	006386700	FL
2	253Z00000X	In Home Supportive Care Agency	002552700	FL
3	253Z00000X	In Home Supportive Care Agency	006386700	FL
4	385H00000X	Respite Care	002552700	FL
5	385H00000X	Respite Care	006386700	FL
6	385HR2055X	Child Mental Illness Respite Care	002552700	FL
7	385HR2055X	Child Mental Illness Respite Care	006386700	FL
8	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	002552700	FL
9	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	006386700	FL
10	385HR2065X	Child Physical Disabilities Respite Care	002552700	FL
11	385HR2065X	Child Physical Disabilities Respite Care	006386700	FL
12	251E00000X	Home Health Agency	002552700	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	16814	OTHER	FL	HOMEMAKER AND COMPANION SERVICES

General Provider Information

NPI Number	:	1841723020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWESOME STEP DEVELOPMENT

Provider Business Mailing Address
First Line	:	6316 SAN JUAN AVE
Second Line	:	STE. 15A
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2831
Country	:	US
Telephone Number	:	904-802-7163
Fax Number	:	904-672-7654

Provider Business Practice Location Address
First Line	:	6316 SAN JUAN AVE
Second Line	:	STE. 15A
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2831
Country	:	US
Telephone Number	:	904-802-7163
Fax Number	:	904-672-7654

Authorized Official
Title or Position	:	OWNER
Name	:	HELEN AMOS
Credential	:
Telephone Number	:	904-908-0014

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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Practice Location Address:

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1720155468 — MR. JAMES KEVIN BAILEY M.S.
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1538226634 — REBECCA JOY VAN DELLEN MSW
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6316 SAN JUAN AVE , SUITE 41
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Practice Fax:

1285888073 — ADRIA PRATT FORTE LMHC
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1578878377 — MS. KIMBERLY FRINE' SPEARING M.S.
Practice Location Address:

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1932719333 — G A C SUPPORT SERVICES LLC
Practice Location Address:

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Directions to “AWESOME STEP DEVELOPMENT ” Practice Location

Language	Start Address	Practice Location

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