Provider Demographics
NPI:1124196308
Name:BLAIR SENIOR SERVICES, INC.
Entity Type:Organization
Organization Name:BLAIR SENIOR SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-946-1235
Mailing Address - Street 1:1320 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3308
Mailing Address - Country:US
Mailing Address - Phone:814-946-1235
Mailing Address - Fax:814-949-4857
Practice Address - Street 1:1320 12TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3308
Practice Address - Country:US
Practice Address - Phone:814-946-1235
Practice Address - Fax:814-949-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001713736-0001Medicaid
PA0017137360002Medicaid
PA0017137360002Medicaid