MEDICARE: BLAST-OFF DAY PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1023983806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAST-OFF DAY PROGRAM

Provider Business Mailing Address
First Line	:	1114 HOPE MILLS RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4247
Country	:	US
Telephone Number	:	910-303-1702
Fax Number	:

Provider Business Practice Location Address
First Line	:	1114 HOPE MILLS RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4247
Country	:	US
Telephone Number	:	910-303-1702
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	KIM LANDRY
Credential	:
Telephone Number	:	910-303-1702

Provider Enumeration Date	:	10/09/2025
Last Update Date	:	10/09/2025

Similar Medicare Providers

1558482463 — AMBASSADORS HOME CARE SERVICES, INC
Practice Location Address:

1104 HOPE MILLS RD , SUITE B
FAYETTEVILLE, NC
28304-4247

Practice Phone: 910-920-2520
Practice Fax: 910-920-2806

1982499158 — BLASTOFF ADULT CARE HOME
Practice Location Address:

1114 HOPE MILLS RD
FAYETTEVILLE, NC
28304-4247

Practice Phone: 910-303-1702
Practice Fax:

1265223143 — BLASTOFF ADULT CARE HOME
Practice Location Address:

1114 HOPE MILLS RD
FAYETTEVILLE, NC
28304

Practice Phone: 910-303-1702
Practice Fax:

1689860439 — FAUZIA BAQAI M.D.
Practice Location Address:

413 OWEN DR STE 101
FAYETTEVILLE, NC
28304-3490

Practice Phone: 910-609-3750
Practice Fax: 910-615-9653

1154345346 — DORRETTE PATRICE GRANT MD
Practice Location Address:

1341 WALTER REED RD
FAYETTEVILLE, NC
28304-4415

Practice Phone: 910-615-3500
Practice Fax:

1033600085 — DR. SAMANTHA LYNN HORVATH BRIDGES DO
Practice Location Address:

1638 OWEN DR # 138
FAYETTEVILLE, NC
28304-3424

Practice Phone: 910-615-4430
Practice Fax: 910-615-9872

Directions to “BLAST-OFF DAY PROGRAM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.