Organization
BLAKE HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE BLAKE (OWNER)
(352) 504-6979
Entity
Organization
Contact information
Practice address
15085 SE 73RD AVE, SUMMERFIELD, FL 34491-4226
(352) 504-6979
Mailing address
15085 SE 73RD AVE, SUMMERFIELD, FL 34491-4226
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
691440
ATN
FL
Enumeration date
01/12/2018
Last updated
01/12/2018
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