Healthcare Provider Details

I. General information

NPI: 1679395768
Provider Name (Legal Business Name): HEMLOCK FARMS - BLOOMING GROVE AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

368 HEMLOCK FARMS ROAD
LORDS VALLEY PA
18428
US

IV. Provider business mailing address

PO BOX 535
BALDWINSVILLE NY
13027-0535
US

V. Phone/Fax

Practice location:
  • Phone: 570-775-3774
  • Fax: 315-635-3289
Mailing address:
  • Phone: 800-927-5845
  • Fax: 315-635-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNA LONG
Title or Position: EMS SUPERVISOR
Credential:
Phone: 201-407-5787