Healthcare Provider Details

I. General information

NPI: 1811270580
Provider Name (Legal Business Name): BLN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 OLD YORK RD 1ST FLOOR
ABINGTON PA
19001-1716
US

IV. Provider business mailing address

1614 OLD YORK RD 1ST FLOOR
ABINGTON PA
19001-1716
US

V. Phone/Fax

Practice location:
  • Phone: 215-366-5955
  • Fax:
Mailing address:
  • Phone: 215-366-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number284904
License Number StatePA

VIII. Authorized Official

Name: MRS. NATALIE LEKISHVILI
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 215-833-2464