Healthcare Provider Details

I. General information

NPI: 1689528176
Provider Name (Legal Business Name): BJ & D COMMUNITY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 ORTON ST
JACKSONVILLE FL
32205-6348
US

IV. Provider business mailing address

1255 ORTON ST
JACKSONVILLE FL
32205-6348
US

V. Phone/Fax

Practice location:
  • Phone: 904-343-9230
  • Fax:
Mailing address:
  • Phone: 904-343-9230
  • Fax: 904-369-0644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MERTICIA BLACK
Title or Position: OWNER
Credential:
Phone: 904-343-9230