Healthcare Provider Details

I. General information

NPI: 1891629762
Provider Name (Legal Business Name): BLAKE R WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GENERAL SERVICE APPRAISER

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 GUERRERO ST
SAN FRANCISCO CA
94103-1014
US

IV. Provider business mailing address

19414 N 25TH ST
PHOENIX AZ
85050-1977
US

V. Phone/Fax

Practice location:
  • Phone: 480-442-4084
  • Fax:
Mailing address:
  • Phone: 480-442-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: