Provider Demographics
NPI:1265626865
Name:BLENDING FAMILIES, INC.
Entity type:Organization
Organization Name:BLENDING FAMILIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIERNOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-838-9904
Mailing Address - Street 1:800 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002
Mailing Address - Country:US
Mailing Address - Phone:847-838-9904
Mailing Address - Fax:847-838-9907
Practice Address - Street 1:800 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002
Practice Address - Country:US
Practice Address - Phone:847-838-9904
Practice Address - Fax:847-838-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1063519510OtherLCPC
IL1457579625OtherLCPC
IL1023020815OtherLCPC
IL1902927791OtherLCPC