Organization
BLAKELY BOROUGH COMMUNITY AMBULANCE ASSOCIATION
Active
Other names
Bakely EMS & Rescue
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF CRUCIANI (FINANCIAL SECRETARY)
(570) 241-6828
Entity
Organization
Contact information
Practice address
500 ACADEMY ST, PECKVILLE, PA 18452-1604
(570) 307-1279
(570) 307-1275
Mailing address
PO BOX 1846, SHAVERTOWN, PA 18708-0846
(570) 714-3694
(570) 714-3695
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
04061
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012562900002
—
PA
01
—
287403
FREEDOM BLUE
PA
01
—
899215
FEDERAL BLACK LUNG
—
Enumeration date
11/22/2006
Last updated
08/27/2012
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