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General NPI Number Information
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NPI Number | 1346681129
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Entity Type | Organization
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Legal Business Name | BLAIR GROUP HOME
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 211 N SPARKMAN AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-5011
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Country | US
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Telephone | 386-775-2165
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Fax | 386-775-3165
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Provider Business Mailing Address
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Address Line | 211 N SPARKMAN AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-5011
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Country | US
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Telephone | 386-775-2165
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Fax | 386-775-3165
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CRAIG ALAN BLAIR
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Credential |
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Telephone | 386-837-3125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 678316396
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 678316396
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License Number State | FL
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