MEDICARE: BUILDING BLOCKS PEDIATRIC HOME HEALTH SERVICES

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	163WH0200X	Home Health Registered Nurse

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164419990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING BLOCKS PEDIATRIC HOME HEALTH SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 779
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29202-0779
Country	:	US
Telephone Number	:	813-890-8004
Fax Number	:	813-290-9691

Provider Business Practice Location Address
First Line	:	6 JOURNEY
Second Line	:	SUITES 135
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-5317
Country	:	US
Telephone Number	:	813-890-8004
Fax Number	:	813-290-9691

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RON MILLS
Credential	:
Telephone Number	:	813-890-8004

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	05/19/2011

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