Provider Demographics
NPI:1063017754
Name:OVER THE TOP SERVICES AND CARE, INC.
Entity Type:Organization
Organization Name:OVER THE TOP SERVICES AND CARE, INC.
Other - Org Name:OVER THE TOP COMPANION SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UREKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-522-3118
Mailing Address - Street 1:345 PONCE HARBOR DR APT 104
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5115
Mailing Address - Country:US
Mailing Address - Phone:904-522-3118
Mailing Address - Fax:
Practice Address - Street 1:345 PONCE HARBOR DR APT 104
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5115
Practice Address - Country:US
Practice Address - Phone:904-522-3118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014116500Medicaid