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General NPI Number Information
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NPI Number | 1134679145
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Entity Type | Organization
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Legal Business Name | BLANCHARD VALLEY CONTINUING CARE SERVICES
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 1000 INDEPENDENCE AVE
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City | FOSTORIA
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State | OH
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Zip | 44830-9614
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Country | US
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Telephone | 419-435-8505
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 INDEPENDENCE AVE
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City | FOSTORIA
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State | OH
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Zip | 44830-9614
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Country | US
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Telephone | 419-435-8505
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BRIDGETT MARIE MUNDY
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Credential | LNHA
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Telephone | 419-435-8505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1951N
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1951N
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1951N
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License Number State | OH
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