Healthcare Provider Details

I. General information

NPI: 1225039274
Provider Name (Legal Business Name): BLAKELY CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 STERLING DR
NORTH BALTIMORE OH
45872
US

IV. Provider business mailing address

600 STERLING DR
NORTH BALTIMORE OH
45872
US

V. Phone/Fax

Practice location:
  • Phone: 419-257-2421
  • Fax: 419-257-2515
Mailing address:
  • Phone: 419-257-2421
  • Fax: 419-257-2515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1652
License Number StateOH

VIII. Authorized Official

Name: MR. DOUGLAS CHARLES BLAKELY
Title or Position: ADMINISTRATOR/OWNER
Credential: LNHA
Phone: 419-257-2421