Provider Demographics
NPI:1962490409
Name:TOWN OF HOOSICK RESCUE SQUAD, INC
Entity type:Organization
Organization Name:TOWN OF HOOSICK RESCUE SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLARKSON
Authorized Official - Last Name:KERVIN
Authorized Official - Suffix:II
Authorized Official - Credentials:AEMT
Authorized Official - Phone:518-686-4106
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-0787
Mailing Address - Country:US
Mailing Address - Phone:888-603-2455
Mailing Address - Fax:
Practice Address - Street 1:21 FIRST STREET
Practice Address - Street 2:
Practice Address - City:HOOSICK FALLS
Practice Address - State:NY
Practice Address - Zip Code:12090
Practice Address - Country:US
Practice Address - Phone:518-686-4105
Practice Address - Fax:315-635-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
NY4125341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1962490Medicaid
590007978OtherRAILROAD MEDICARE
NY01365824Medicaid