Provider Demographics
NPI:1912229386
Name:BLAKE HEALTH MANAGEMENT INC
Entity Type:Organization
Organization Name:BLAKE HEALTH MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ONYEBUCHI
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:AGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-445-1013
Mailing Address - Street 1:4956 VERDUGO WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8632
Mailing Address - Country:US
Mailing Address - Phone:805-445-1013
Mailing Address - Fax:805-445-4526
Practice Address - Street 1:4956 VERDUGO WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8632
Practice Address - Country:US
Practice Address - Phone:805-445-1013
Practice Address - Fax:805-445-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53425332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101436649OtherCALIFORNIA SELLER'S PERMIT