Provider Demographics
NPI:1952465072
Name:BLM INCORPORATED
Entity type:Organization
Organization Name:BLM INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRENK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:808-877-6222
Mailing Address - Street 1:53 S PUUNENE AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2121
Mailing Address - Country:US
Mailing Address - Phone:808-871-5144
Mailing Address - Fax:808-877-2430
Practice Address - Street 1:53 S PUUNENE AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2121
Practice Address - Country:US
Practice Address - Phone:808-871-5144
Practice Address - Fax:808-877-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-28445163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA 020670-4OtherHMSA
HI9233636OtherUHA
HI541585OtherHMA
HI541585OtherHMA
HI541585OtherHMA