# BLAKE IN HOME HEALTH SERVICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063998276
- **Authorized official:** THOMAS EVERTT BLAKE SR. DO (OWNER)
- **Authorized official phone:** (314) 243-6745

## Contact information

- **Practice address:** 7220 N LINDBERGH BLVD \# 210, HAZELWOOD, MO 63042-2019
- **Practice address phone:** (314) 224-8411
- **Mailing address:** 7220 N LINDBERGH BLVD \# 210, HAZELWOOD, MO 63042-2019
- **Mailing address phone:** (314) 224-8411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | — | NULL | Yes |
| 163WH0200X | Home Health Registered Nurse | — | — | Yes |
| 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