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General NPI Number Information
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NPI Number | 1679265482
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Entity Type | Organization
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Legal Business Name | THE BLAKE AT CHARLOTTESVILLE SERVICES, LLC
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 250 NICHOLS COURT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901
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Country | US
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Telephone | 434-973-7900
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Fax | 434-328-7315
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Provider Business Mailing Address
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Address Line | 250 NICHOLS COURT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901
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Country | US
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Telephone | 434-973-7900
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Fax | 434-328-7315
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DAVID CRANDALL TER BORG
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Credential |
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Telephone | 434-973-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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