# BLAKE HOME HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blake Home Healthcare, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356967145
- **Authorized official:** CHARLES MONTEL MAYO (DIRECTOR/PRESIDENT)
- **Authorized official phone:** (804) 545-1974

## Contact information

- **Practice address:** 5709 S LABURNUM AVE, RICHMOND, VA 23231-4420
- **Practice address phone:** (804) 545-1974
- **Mailing address:** 3524 CARTER RD, PORTSMOUTH, VA 23703-3811
- **Mailing address phone:** (757) 637-5073

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | — | Yes |

## Other

- **Enumeration date:** 06/17/2020
- **Last updated:** 06/17/2020