Organization
CHENOA AMBULANCE SERVICE ASSOCIATION
Active
Other names
CASA
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP D HARLAND (TREASURER)
(815) 945-7156
Entity
Organization
Contact information
Practice address
920 E CEMETERY AVE, CHENOA, IL 61726-1239
(815) 945-7156
(815) 945-7532
Mailing address
PO BOX 182, 920 E CEMETERY AVE, CHENOA, IL 61726-0182
(815) 945-7156
(815) 945-7532
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
026709
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05732089
BLUE CROSS BLUE SHIELD
IL
Enumeration date
02/23/2007
Last updated
07/27/2008
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