1366469215 NPI number — CITY OF CRYSTAL LAKE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366469215 NPI number — CITY OF CRYSTAL LAKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CRYSTAL LAKE
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:
6
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:
1366469215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PIERCE PL STE 750W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ITASCA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60143-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-678-0865
Provider Business Mailing Address Fax Number:
888-464-4429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W WOODSTOCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60014-4262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-459-2020
Provider Business Practice Location Address Fax Number:
815-477-2568
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SNYDER
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
815-459-2020

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  7140 , 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: 0004531041 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5670002 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 590028206 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com