=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053429555
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUEPRINT TECHNOLOGIES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4420 CINNABAR CT #2A
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27409-8646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-337-7823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 703
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27282-0703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-337-7823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/ADMINISTRATOR
-----------------------------------------------------
Name | MRS. MARIA RODRIGUEZ-DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-337-7823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC3413
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------