Provider Demographics
NPI:1679265482
Name:THE BLAKE AT CHARLOTTESVILLE SERVICES, LLC
Entity type:Organization
Organization Name:THE BLAKE AT CHARLOTTESVILLE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CRANDALL
Authorized Official - Last Name:TER BORG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-973-7900
Mailing Address - Street 1:250 NICHOLS COURT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-973-7900
Mailing Address - Fax:434-328-7315
Practice Address - Street 1:250 NICHOLS COURT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-973-7900
Practice Address - Fax:434-328-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances