| Organization Name: | BLACK CREEK SUPPORTS AND SERVICES, INC. |
| NPI Number: | 1902214174 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHIELA BRYANT BUTLER (PRESIDENT) |
| Mailing Address: | 1700 Lismore Ct Middleburg |
| State: | FL US |
| Postal Code: | 320686703 |
| Phone Number: | 9044492699 |
| Fax Number: | 9043752019 |
| NPI Enumeration Date: | 07/31/2014 |
| NPI Last Update Date: | 07/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 232967 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |