Provider Demographics
NPI:1780415885
Name:A BLENDED FAMILY HOME CARE, LLC
Entity type:Organization
Organization Name:A BLENDED FAMILY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:SHERELLE
Authorized Official - Last Name:QUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-703-8345
Mailing Address - Street 1:3214 E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3307
Mailing Address - Country:US
Mailing Address - Phone:443-703-8345
Mailing Address - Fax:410-305-6221
Practice Address - Street 1:3214 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3307
Practice Address - Country:US
Practice Address - Phone:443-703-8345
Practice Address - Fax:410-305-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care