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NPI Code Detail

MEDICARE: BLACKSTONE HEALTHCARE, INC.

MEDICARE: BLACKSTONE HEALTHCARE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1760667505
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACKSTONE HEALTHCARE, INC.
Provider Business Mailing Address
First Line : 3040 KETTERING BLVD
Second Line :
City : MORAINE
State : OH
Zip : 45439-1922
Country : US
Telephone Number : 937-643-2422
Fax Number : 937-643-2415
Provider Business Practice Location Address
First Line : 3040 KETTERING BLVD
Second Line :
City : MORAINE
State : OH
Zip : 45439-1922
Country : US
Telephone Number : 937-643-2422
Fax Number : 937-643-2415
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. DAVID L TRAMONTANA
Credential :
Telephone Number : 937-643-2422
Provider Enumeration Date : 12/28/2007
Last Update Date : 12/28/2007

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