GLENN R BLACKLOCK Nursing Home Administrator License verification

Business Entity

NOT RENEWED

License Type

Nursing Home Administrator

Description

LICENSED NURSING HOME ADMINISTRATOR TEMPORARY

License Number

045002354

License Status

NOT RENEWED

Business

First Name

GLENN R

Last Name

BLACKLOCK

Business Name

GLENN R BLACKLOCK

Original Issue Date

11/21/1995

Expiration Date

09/18/1996

City

SAVANNA

State

Zip

61074

County

CARROLL

Ever Disciplined

LastModifiedDate

05/31/2005