1043374481 NPI number — VILLAGE OF RICHTON PARK

Table of content: (NPI 1043374481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043374481 NPI number — VILLAGE OF RICHTON PARK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF RICHTON PARK
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:
1043374481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1053
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOKENA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60448-2052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-478-5694
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4455 SAUK TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHTON PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60471-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-233-1170
Provider Business Practice Location Address Fax Number:
773-233-8146
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
708-478-5694

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  891001 , 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: 1634154 . This is a "BC BS ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1634154 . This is a "HMO ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 590009158 . This is a "RAILROAD RETIREMENT" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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