=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659238988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C BLAKE RESILIENCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 HAGGERTY RD STE 2160
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48323-2192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-251-3513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 HAGGERTY RD STE 2160
-----------------------------------------------------
City | WEST BLOOMFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48323-2192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-251-3513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CYRIL BLAKE DAVIS
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 248-251-3513
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------