Provider Demographics
NPI:1174500326
Name:SEVENTH WARD CIVIC ASSOCIATION
Entity Type:Organization
Organization Name:SEVENTH WARD CIVIC ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-535-8881
Mailing Address - Street 1:404 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15902-2022
Mailing Address - Country:US
Mailing Address - Phone:814-535-8881
Mailing Address - Fax:814-535-8750
Practice Address - Street 1:404 CEDAR ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15902-2022
Practice Address - Country:US
Practice Address - Phone:814-535-8881
Practice Address - Fax:814-535-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05206341600000X, 3416L0300X, 343900000X
PAA00114036343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008959010001Medicaid
PA0008959010001Medicaid