Provider Demographics
NPI:1992468805
Name:BLENDED FAMILY HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:BLENDED FAMILY HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEST-CUNDIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-268-8799
Mailing Address - Street 1:903 30TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1405
Mailing Address - Country:US
Mailing Address - Phone:330-268-8799
Mailing Address - Fax:
Practice Address - Street 1:903 30TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-1405
Practice Address - Country:US
Practice Address - Phone:330-268-8799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0454288Medicaid