Organization
BLAKE RESIDENTIAL INC
Active
Organization
BLAKE RESIDENTIAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIERRA BLAKE (CEO)
(209) 905-6773
Entity
Organization
Contact information
Practice address
9549 TWIN BROOKS LN, STOCKTON, CA 95219-4931
(209) 905-6773
Mailing address
9549 TWIN BROOKS LN, STOCKTON, CA 95219-4931
(209) 905-6773
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
311ZA0620X
Adult Care Home Facility
—
—
Other
Enumeration date
08/26/2024
Last updated
08/30/2024
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