Healthcare Provider Details

I. General information

NPI: 1356982151
Provider Name (Legal Business Name): THE BLAKE SITTER SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 MAIN ST S
ALLENDALE SC
29810-4202
US

IV. Provider business mailing address

832 MAIN ST S
ALLENDALE SC
29810-4202
US

V. Phone/Fax

Practice location:
  • Phone: 803-662-4749
  • Fax: 833-836-5557
Mailing address:
  • Phone: 803-662-4749
  • Fax: 833-836-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MRS. NOVELLA JACKSON
Title or Position: OWNER
Credential:
Phone: 803-662-4749