Provider Demographics
NPI:1972210037
Name:BLONDELS HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BLONDELS HEALTH SERVICES LLC
Other - Org Name:BLONDEL'S HEALTH SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLONDEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:339-837-1449
Mailing Address - Street 1:5 SCALLY CIR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2443
Mailing Address - Country:US
Mailing Address - Phone:339-837-1449
Mailing Address - Fax:339-837-1076
Practice Address - Street 1:5 SCALLY CIR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2443
Practice Address - Country:US
Practice Address - Phone:339-837-1449
Practice Address - Fax:339-837-1076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110202833AMedicaid