1013923804 NPI number — VILLAGE OF FOREST VIEW

Table of content: (NPI 1013923804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013923804 NPI number — VILLAGE OF FOREST VIEW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF FOREST VIEW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013923804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
395 W. LAKE ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-530-2988
Provider Business Mailing Address Fax Number:
630-903-2831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 W 46TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST VIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60402-4355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-749-1110
Provider Business Practice Location Address Fax Number:
708-749-9301
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
MARK
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
708-749-1110

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  88152 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016-33733 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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