Provider Demographics
NPI:1487376331
Name:BLENDED AQUATICS LLC
Entity type:Organization
Organization Name:BLENDED AQUATICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO- FOUNDER/ BCBA
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:952-212-0294
Mailing Address - Street 1:265 FEDERAL AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-2463
Mailing Address - Country:US
Mailing Address - Phone:952-212-0294
Mailing Address - Fax:
Practice Address - Street 1:265 FEDERAL AVE APT 24
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2463
Practice Address - Country:US
Practice Address - Phone:952-212-0294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health