Provider Demographics
NPI:1093049504
Name:GREENWOOD LAKE AMBULANCE, INC.
Entity Type:Organization
Organization Name:GREENWOOD LAKE AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIFFLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-721-5682
Mailing Address - Street 1:74 WINDERMERE AVE
Mailing Address - Street 2:P.O. BOX 223
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-0223
Mailing Address - Country:US
Mailing Address - Phone:845-477-2200
Mailing Address - Fax:
Practice Address - Street 1:74 WINDERMERE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD LAKE
Practice Address - State:NY
Practice Address - Zip Code:10925-0223
Practice Address - Country:US
Practice Address - Phone:845-477-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport