Healthcare Provider Details

I. General information

NPI: 1396798989
Provider Name (Legal Business Name): LIFE FORCE OF WESTERN PA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 6TH AVE
GREENVILLE PA
16125-1237
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 724-589-0665
  • Fax: 724-589-0667
Mailing address:
  • Phone: 315-635-1789
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number04183
License Number StatePA

VIII. Authorized Official

Name: DAVID SHILLING
Title or Position: PRESIDENT
Credential:
Phone: 724-589-0665