Provider Demographics
NPI:1740046556
Name:BLENDED COMMUNITIES, LLC
Entity type:Organization
Organization Name:BLENDED COMMUNITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANOVA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MITCHENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-924-0443
Mailing Address - Street 1:1718 N KING ST STE 204
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1910
Mailing Address - Country:US
Mailing Address - Phone:757-600-7642
Mailing Address - Fax:888-860-3261
Practice Address - Street 1:1718 N KING ST STE 204
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-1910
Practice Address - Country:US
Practice Address - Phone:757-600-7642
Practice Address - Fax:888-860-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities