Blake, Michael Leeroy

Blake, Michael Leeroy is an individual health care provider with primary practice located at 27 Boulder Rd , Glendale WV 26038. He recently has only one registered license in Nursing Service Related Providers / Personal Care Attendant, which is considered as his primary health care specialty. Blake, Michael Leeroy can be contacted via phone (304) 650-1797.

Contact Information

Primary practice address
27 Boulder Rd Glendale WV 26038
Phone: (304) 650-1797
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Related Providers / Personal Care Attendant 3747P1801X

Profile Details

NPI number 1922729094
LBN Legal business name Blake, Michael Leeroy
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 7th, 2022
Last updated Sep 7th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922729094 NPPES
West Virginia MEDICAID 1356607394
West Virginia MEDICAID 125553494
West Virginia MEDICAID 1821206228

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