Provider Demographics
NPI:1144649609
Name:BLENDSHIP INC
Entity type:Organization
Organization Name:BLENDSHIP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOERING
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:909-920-9400
Mailing Address - Street 1:222 N MOUNTAIN AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5714
Mailing Address - Country:US
Mailing Address - Phone:909-920-9400
Mailing Address - Fax:909-920-5959
Practice Address - Street 1:222 N MOUNTAIN AVE STE 209
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5714
Practice Address - Country:US
Practice Address - Phone:909-920-9400
Practice Address - Fax:909-920-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3654412OtherCORPORATION NUMBER