| NPI | 1215711122 |
|---|---|
| Doing Business As | BLAKES HOUSE OF INDEPENDENCE |
| Entity Type | Organization |
| Authorized Contact | JAMITA MARTIN CEO 770-634-9994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-08-22 |