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BLAKE PAIN SOLUTIONS PC

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Company Details

Legal Name: BLAKE PAIN SOLUTIONS PC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: January 1st 2012
Date of Dissolution: May 1st 2013
Expiration date: 31 Jan 2013
UBI Number: 603 167 598
ZIP code: 98668
County: CLARK
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 2312 NE 129TH AVENUE, VANCOUVER, WA, 98668, UNITED STATES

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Registered Agent Information

Name Role Address
JACOB BLAKE Registered Agent 2312 NE 129TH AVENUE, VANCOUVER, WA, 98668, UNITED STATES

Key Officers & Management

Name Role Address
JACOB BLAKE Governing Person 3920 NE HOYT ST, PORTLAND, OR, 97232, UNITED STATES
WILLIAM DU VAL INCORPORATOR P.O. BOX 96174, PORTLAND, OR, 97296, UNITED STATES

National Provider Identifier

NPI Number:
1063784700

Authorized Person:

Name:
DR. JACOB LEROY BLAKE
Role:
CEO/PHYSICIAN
Phone:

Taxonomy:

Selected Taxonomy:
261QP3300X - Pain Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
3606965445
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