Healthcare Provider Details

I. General information

NPI: 1508797218
Provider Name (Legal Business Name): BLU GEM SUPPORTIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 27TH ST SW
LEHIGH ACRES FL
33976-4069
US

IV. Provider business mailing address

2815 27TH ST SW
LEHIGH ACRES FL
33976-4069
US

V. Phone/Fax

Practice location:
  • Phone: 239-265-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARNEISHA BROWN
Title or Position: ADMINISTRATOR
Credential:
Phone: 239-265-8500