Healthcare Provider Details

I. General information

NPI: 1740946946
Provider Name (Legal Business Name): OFF THE BLOCK PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 BYRD AVE UNIT 3
CINCINNATI OH
45215-2223
US

IV. Provider business mailing address

1022 BYRD AVE UNIT 3
CINCINNATI OH
45215-2223
US

V. Phone/Fax

Practice location:
  • Phone: 513-560-1153
  • Fax:
Mailing address:
  • Phone: 513-560-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SYNAMON BRANDI DENISE ROSEMOND
Title or Position: OWNER
Credential:
Phone: 513-560-1153