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General NPI Number Information
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NPI Number | 1841738341
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Entity Type | Organization
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Legal Business Name | BOULEVARD VAN CITY LLC
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 2708 NIAGARA FALLS BLVD
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City | NIAGARA FALLS
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State | NY
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Zip | 14304-4517
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Country | US
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Telephone | 716-731-4335
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Fax | 716-731-4331
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Provider Business Mailing Address
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Address Line | 2708 NIAGARA FALLS BLVD
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City | NIAGARA FALLS
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State | NY
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Zip | 14304-4517
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Country | US
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Telephone | 716-731-4335
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Fax | 716-731-4331
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Authorized Official
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Title or Position | OWNER
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Name | MR. FRANK J SOUTHERLAND
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Credential |
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Telephone | 716-731-4335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State |
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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 |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 171WV0202X
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Taxonomy Name | Vehicle Modifications Contractor
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License Number |
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License Number State |
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