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General NPI Number Information
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NPI Number | 1760716229
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Entity Type | Organization
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Legal Business Name | BLANDFORD FAMILY SERVICES LLC
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 2703 TIPTON ST
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-5246
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Country | US
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Telephone | 804-605-1800
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Fax | 804-318-1569
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Provider Business Mailing Address
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Address Line | 5007 DAMPIER CT
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City | CHESTER
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State | VA
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Zip | 23831-6640
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Country | US
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Telephone | 804-605-1800
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Fax | 804-318-1569
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. IRVIN BLANDFORD
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Credential |
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Telephone | 804-605-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 1063-14-001
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License Number State | VA
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