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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
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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