Blake Residential Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BLAKE RESIDENTIAL INC

Practice address

9549 Twin Brooks LN
Stockton, CA 95219-4931

Phone

(209) 905-6773

NPI assigned

Aug 26, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mierra BlakeNPI 1053003939

Title

Ceo

Phone

(209) 905-6773

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mierra Mary Blake

  • Marriage & Family Therapist
  • Sacramento, CA
  • NPI 1053003939
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724976000000",
    "number": "1356174239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9549 TWIN BROOKS LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952194931",
            "telephone_number": "209-905-6773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9549 TWIN BROOKS LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952194931",
            "telephone_number": "209-905-6773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE RESIDENTIAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "MIERRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-905-6773"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracey Black
• Wilnika Lanima Black
• Demerica Blackman-Baldoza
• Lena Charlene Blackshear, PTA
• John E Blades, DDS
• Diana Blakely
• Jarred Lavell Blakely
• Alex Blalock
• Madison Blanc, M.S., SLP
• Clara Concepcion Blanco-Herrada, LMFT

• Assisted Living Facility in Stockton, CA
• Providers in Stockton, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.