Healthcare Provider Details

I. General information

NPI: 1699431148
Provider Name (Legal Business Name): WEST SHORE ADVANCED LIFE SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 WOODBINE LN
DANVILLE PA
17821-8020
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

V. Phone/Fax

Practice location:
  • Phone: 800-367-0512
  • Fax: 717-972-4753
Mailing address:
  • Phone: 717-763-2108
  • Fax: 717-972-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name: CINDY L MULL
Title or Position: DIRECTOR SYSTEM CREDENTIALING
Credential:
Phone: 570-271-6603