Provider Demographics
NPI:1740946946
Name:OFF THE BLOCK PROGRAM
Entity type:Organization
Organization Name:OFF THE BLOCK PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SYNAMON
Authorized Official - Middle Name:BRANDI DENISE
Authorized Official - Last Name:ROSEMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-560-1153
Mailing Address - Street 1:1022 BYRD AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2223
Mailing Address - Country:US
Mailing Address - Phone:513-560-1153
Mailing Address - Fax:
Practice Address - Street 1:1022 BYRD AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2223
Practice Address - Country:US
Practice Address - Phone:513-560-1153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0038672Medicaid