Provider Demographics
NPI:1922510684
Name:BVC ALLIES
Entity Type:Organization
Organization Name:BVC ALLIES
Other - Org Name:1ST ALLIANCE PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LEBOGANG
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-803-2907
Mailing Address - Street 1:26 E MARSHALL RD
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1201
Mailing Address - Country:US
Mailing Address - Phone:610-803-2907
Mailing Address - Fax:
Practice Address - Street 1:26 E MARSHALL RD
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1201
Practice Address - Country:US
Practice Address - Phone:610-803-2907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========Medicaid