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General NPI Number Information
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NPI Number | 1801212964
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Entity Type | Organization
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Legal Business Name | BLAKE'S MOBILE CARE
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 821 KAITLYN DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-6928
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Country | US
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Telephone | 910-977-8699
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Fax | 770-710-0862
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Provider Business Mailing Address
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Address Line | 821 KAITLYN DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-6928
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Country | US
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Telephone |
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Fax | 770-710-0862
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Authorized Official
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Title or Position | OWNER
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Name | WAYNE BLAKE
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Credential |
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Telephone | 910-977-8699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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