Provider Demographics
NPI:1174189021
Name:BLACK BEAR CS, INC.
Entity Type:Organization
Organization Name:BLACK BEAR CS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-551-7599
Mailing Address - Street 1:804 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1062
Mailing Address - Country:US
Mailing Address - Phone:845-551-7599
Mailing Address - Fax:724-383-3062
Practice Address - Street 1:804 DELAWARE DR
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1062
Practice Address - Country:US
Practice Address - Phone:845-551-7599
Practice Address - Fax:724-383-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)