Provider Demographics
NPI:1366987737
Name:BLANCHARD VALLEY RESIDENTIAL SERVICES, INC.
Entity type:Organization
Organization Name:BLANCHARD VALLEY RESIDENTIAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONIFAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-422-6503
Mailing Address - Street 1:1701 E MAIN CROSS ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-7064
Mailing Address - Country:US
Mailing Address - Phone:419-422-6503
Mailing Address - Fax:
Practice Address - Street 1:1701 E MAIN CROSS ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-7064
Practice Address - Country:US
Practice Address - Phone:419-422-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3210028320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities