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General NPI Number Information
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NPI Number | 1689528176
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Entity Type | Organization
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Legal Business Name | BJ & D COMMUNITY SUPPORT SERVICES
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Dates
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Enumeration Date | 02/23/2026
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Last Update Date | 02/23/2026
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Provider Practice Location Address
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Address Line | 1255 ORTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-6348
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Country | US
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Telephone | 904-343-9230
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 ORTON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-6348
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Country | US
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Telephone | 904-343-9230
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Fax | 904-369-0644
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Authorized Official
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Title or Position | OWNER
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Name | MS. MERTICIA BLACK
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Credential |
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Telephone | 904-343-9230
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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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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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