Provider Demographics
NPI:1760667505
Name:BLACKSTONE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:BLACKSTONE HEALTHCARE, INC.
Other - Org Name:BLACK STONE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:TRAMONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-643-2422
Mailing Address - Street 1:3040 KETTERING BLVD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1922
Mailing Address - Country:US
Mailing Address - Phone:937-643-2422
Mailing Address - Fax:937-643-2415
Practice Address - Street 1:3040 KETTERING BLVD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1922
Practice Address - Country:US
Practice Address - Phone:937-643-2422
Practice Address - Fax:937-643-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health