Healthcare Provider Details

I. General information

NPI: 1962490409
Provider Name (Legal Business Name): TOWN OF HOOSICK RESCUE SQUAD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 FIRST STREET
HOOSICK FALLS NY
12090
US

IV. Provider business mailing address

PO BOX 787
LATHAM NY
12110-0787
US

V. Phone/Fax

Practice location:
  • Phone: 518-686-4105
  • Fax: 315-635-3289
Mailing address:
  • Phone: 888-603-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number4125
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN CLARKSON KERVIN II
Title or Position: CHIEF OF OPERATIONS
Credential: AEMT
Phone: 518-686-4106