=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326904533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOH HEALTH AND EDUCATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2025
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 NW MAIN BLVD UNIT 725
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32055-9998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-344-8355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 725
-----------------------------------------------------
City | LAKE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32056-0725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-344-8355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND PROVIDER
-----------------------------------------------------
Name | DECARLOS SCIPPIO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 386-344-8355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------