=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720957897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLENDEDTRADITIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2025
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 30TH ST NW BLDG B STE 101B
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44709-2959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-354-9042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 30TH ST NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44709-2959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-354-9042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | TASHA HARRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-354-9042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------