Healthcare Provider Details

I. General information

NPI: 1063017754
Provider Name (Legal Business Name): OVER THE TOP SERVICES AND CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 PONCE HARBOR DR APT 104
SAINT AUGUSTINE FL
32086-5115
US

IV. Provider business mailing address

345 PONCE HARBOR DR APT 104
SAINT AUGUSTINE FL
32086-5115
US

V. Phone/Fax

Practice location:
  • Phone: 904-522-3118
  • Fax:
Mailing address:
  • Phone: 904-522-3118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: UREKA BLOUNT
Title or Position: CEO
Credential:
Phone: 904-522-3118