Healthcare Provider Details

I. General information

NPI: 1609591361
Provider Name (Legal Business Name): BLOG PLANET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/01/2026
Certification Date: 08/13/2026
Deactivation Date: 09/25/2026
Reactivation Date: 10/01/2026

III. Provider practice location address

9191 R G SKINNER PKWY UNIT 605
JACKSONVILLE FL
32256-9661
US

IV. Provider business mailing address

9191 R G SKINNER PKWY UNIT 605
JACKSONVILLE FL
32256-9661
US

V. Phone/Fax

Practice location:
  • Phone: 508-769-2707
  • Fax: 904-683-5095
Mailing address:
  • Phone: 508-769-2707
  • Fax: 401-305-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. OLIVIA BERGUS
Title or Position: AO
Credential:
Phone: 508-769-2707