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Organization
BLAKE IN HOME HEALTH SERVICE LLC
Active
Organization
BLAKE IN HOME HEALTH SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS EVERTT BLAKE SR. DO (OWNER)
(314) 243-6745
Entity
Organization
Contact information
Practice address
7220 N LINDBERGH BLVD # 210, HAZELWOOD, MO 63042-2019
(314) 224-8411
Mailing address
7220 N LINDBERGH BLVD # 210, HAZELWOOD, MO 63042-2019
(314) 224-8411
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
—
NULL
163WH0200X
Home Health Registered Nurse
Primary
—
—
251E00000X
Home Health Agency
—
MO
253Z00000X
In Home Supportive Care Agency
—
MO
374U00000X
Home Health Aide
—
MO
Other
Enumeration date
07/11/2018
Last updated
02/14/2022
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