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General NPI Number Information
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NPI Number | 1174500326
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Entity Type | Organization
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Legal Business Name | SEVENTH WARD CIVIC ASSOCIATION
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 404 CEDAR ST
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City | JOHNSTOWN
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State | PA
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Zip | 15902-2022
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Country | US
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Telephone | 814-535-8881
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Fax | 814-535-8750
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Provider Business Mailing Address
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Address Line | 404 CEDAR ST
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City | JOHNSTOWN
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State | PA
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Zip | 15902-2022
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Country | US
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Telephone | 814-535-8881
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Fax | 814-535-8750
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD COSTLOW
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Credential |
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Telephone | 814-535-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 05206
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | A00114036
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 05206
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 05206
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License Number State | PA
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