Provider Demographics
NPI:1710209366
Name:DENISE BLAKNEY
Entity type:Organization
Organization Name:DENISE BLAKNEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-553-5175
Mailing Address - Street 1:2363 MERLIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052
Mailing Address - Country:US
Mailing Address - Phone:682-553-5175
Mailing Address - Fax:972-602-6909
Practice Address - Street 1:2363 MERLIN DRIVE
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:682-553-5175
Practice Address - Fax:972-602-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based