# THE BLAKE AT CHARLOTTESVILLE SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Blake at Charlottesville, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679265482
- **Authorized official:** MR. DAVID CRANDALL TER BORG (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (434) 973-7900

## Contact information

- **Practice address:** 250 NICHOLS COURT, CHARLOTTESVILLE, VA 22901
- **Practice address phone:** (434) 973-7900
- **Practice address fax:** (434) 328-7315
- **Mailing address:** 250 NICHOLS COURT, CHARLOTTESVILLE, VA 22901
- **Mailing address phone:** (434) 973-7900
- **Mailing address fax:** (434) 328-7315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NULL | Yes |

## Other

- **Enumeration date:** 05/22/2023
- **Last updated:** 05/22/2023