Individual
KOLISHA BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
6560 NW 11TH ST, MARGATE, FL 33063-3510
(954) 889-4967
Mailing address
705 SW 51ST AVE, MARGATE, FL 33068-3045
(954) 889-4967
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/22/2025
Last updated
07/22/2025
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