| Doctor Name: | ROBERT DEMAREST BLAKE |
| NPI Number: | 1285029389 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 251326-1 |
| Business Practice Address: | 11242 Mills Mills Rd Fillmore, NY - 147358622 |
| Business Phone Number: | 2142231567 |
| Business Fax Number: | |
| Mailing Address: | 11242 Mills Mills Rd, FILLMORE |
| State: | NY |
| Postal Code: | 147358622 |
| Phone Number: | 2142231567 |
| Fax Number: | |
| NPI Enumeration Date: | 04/06/2015 |
| NPI Last Update Date: | 04/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 311ZA0620X |
| License Number: | 251326-1 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Custodial Care Facility |
| Taxonomy Specialization: | Adult Care Home |
| Taxonomy Definition: | A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |