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General NPI Number Information
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NPI Number | 1568381465
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Entity Type | Organization
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Legal Business Name | BJK PROVIDER LLC
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/14/2026
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Provider Practice Location Address
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Address Line | 127 ANHINGA ST
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City | CANTONMENT
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State | FL
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Zip | 32533-9348
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Country | US
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Telephone | 850-287-2066
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Fax | 850-285-0849
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Provider Business Mailing Address
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Address Line | 127 ANHINGA ST
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City | CANTONMENT
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State | FL
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Zip | 32533-9348
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Country | US
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Telephone | 850-287-2066
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Fax | 850-285-0849
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Authorized Official
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Title or Position | MANAGER/PROVIDER
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Name | MS. BARBARA GORAM
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Credential |
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Telephone | 850-287-2066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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