Healthcare Provider Details

I. General information

NPI: 1497120398
Provider Name (Legal Business Name): WILLIAM BLOUNT HOME CARE WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 MISSISSIPPI AVE SE APT 103
WASHINGTON DC
20032-2408
US

IV. Provider business mailing address

237 MISSISSIPPI AVE SE APT 103
WASHINGTON DC
20032-2408
US

V. Phone/Fax

Practice location:
  • Phone: 704-726-8871
  • Fax:
Mailing address:
  • Phone: 704-726-8871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: