Organization
BLACKLICK VALLEY FOUNDATION AND AMBULANCE SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY SHERWOOD-BURNS (PRESIDENT)
(814) 749-7332
Entity
Organization
Contact information
Practice address
1077 1ST ST, NANTY GLO, PA 15943-1159
(814) 749-7332
(814) 749-7188
Mailing address
1077 1ST ST, NANTY GLO, PA 15943-1159
(814) 749-7332
(814) 749-7188
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
03150
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008930680001
—
PA
01
—
281902
PA BLUE SHIELD
PA
01
—
590001284
RAILROAD MEDICARE
PA
Enumeration date
04/17/2006
Last updated
12/07/2012
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