Provider Demographics
NPI:1679387567
Name:BLONNIE'S HOUSE, LLC
Entity type:Organization
Organization Name:BLONNIE'S HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:VANBRAKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-929-5423
Mailing Address - Street 1:12138 CENTRAL AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1910
Mailing Address - Country:US
Mailing Address - Phone:410-929-5423
Mailing Address - Fax:
Practice Address - Street 1:3631 ERDMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1941
Practice Address - Country:US
Practice Address - Phone:410-929-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder