The Blake at Charlottesville Services, LLC

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

Legal business name

THE BLAKE AT CHARLOTTESVILLE SERVICES, LLC

Practice address

250 Nichols Court
Charlottesville, VA 22901

Phone

(434) 973-7900

Fax

(434) 328-7315

NPI assigned

May 22, 2023

Last updated

May 22, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. David Crandall Ter Borg

Title

Executive Director

Phone

(434) 973-7900

Specialties & licenses 1

Addresses

Other names 1

• The Blake at Charlottesville, LLC Former legal business name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1679265482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 NICHOLS COURT",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "22901",
            "telephone_number": "434-973-7900",
            "fax_number": "434-328-7315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 NICHOLS COURT",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "22901",
            "telephone_number": "434-973-7900",
            "fax_number": "434-328-7315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BLAKE AT CHARLOTTESVILLE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "TER BORG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CRANDALL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "434-973-7900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Blake at Charlottesville, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Assisted Living Facility (Behavioral Disturbances) in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Assisted Living Facility (Behavioral Disturbances) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.