Healthcare Provider Details

I. General information

NPI: 1295528362
Provider Name (Legal Business Name): BLOUNT SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 KINGSLEY AVE STE 1
ORANGE PARK FL
32073-4456
US

IV. Provider business mailing address

1728 KINGSLEY AVE STE 1
ORANGE PARK FL
32073-4456
US

V. Phone/Fax

Practice location:
  • Phone: 904-612-3917
  • Fax:
Mailing address:
  • Phone: 904-612-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: RODTEICE BLOUNT
Title or Position: OWNER
Credential:
Phone: 904-612-3917