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General NPI Number Information
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NPI Number | 1487515672
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Entity Type | Organization
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Legal Business Name | BLUE LAKES CARE LLC
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 181 LOLA ST
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City | COLBERT
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State | GA
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Zip | 30628-6644
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Country | US
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Telephone | 706-296-1979
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Fax |
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Provider Business Mailing Address
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Address Line | 181 LOLA ST
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City | COLBERT
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State | GA
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Zip | 30628-6644
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Country | US
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Telephone | 706-296-1979
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JAMES BRETT GABRIEL
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Credential | MBA
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Telephone | 706-296-1979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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