Provider Demographics
NPI:1740153501
Name:BLADE RELIANT
Entity type:Organization
Organization Name:BLADE RELIANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENRICKA
Authorized Official - Middle Name:TAKEISHA
Authorized Official - Last Name:MCSWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:954-258-9923
Mailing Address - Street 1:2617 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-2924
Mailing Address - Country:US
Mailing Address - Phone:954-258-9923
Mailing Address - Fax:
Practice Address - Street 1:2617 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-2924
Practice Address - Country:US
Practice Address - Phone:954-258-9923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies