Provider Demographics
NPI:1265684112
Name:BAL, INC
Entity Type:Organization
Organization Name:BAL, INC
Other - Org Name:WILLOW AIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURE
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-495-6370
Mailing Address - Street 1:32250 PARKS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WILLOW
Mailing Address - State:AK
Mailing Address - Zip Code:99688
Mailing Address - Country:US
Mailing Address - Phone:907-495-6370
Mailing Address - Fax:907-495-6789
Practice Address - Street 1:32250 WEST PARKS HIGHWAY
Practice Address - Street 2:
Practice Address - City:WILLOW
Practice Address - State:AK
Practice Address - Zip Code:99688
Practice Address - Country:US
Practice Address - Phone:907-495-6370
Practice Address - Fax:907-495-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK241558347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAL2361Medicaid