Individual
CHIQUITA BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
340 WOODBINE ST, HARRISBURG, PA 17110-1857
(717) 585-9390
(717) 889-0254
Mailing address
340 WOODBINE ST, HARRISBURG, PA 17110-1857
(717) 585-9390
(717) 889-0254
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
9974394
PA
374U00000X
Home Health Aide
9974394
PA
376J00000X
Homemaker
9974394
PA
376K00000X
Nurse's Aide
Primary
9974394
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4090262
STATE BUSINESS ENTITY NUMBER
PA
Enumeration date
05/19/2012
Last updated
05/19/2012
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