1316990286 NPI number — VILLAGE OF LIBERTYVILLE

Table of content: (NPI 1316990286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316990286 NPI number — VILLAGE OF LIBERTYVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF LIBERTYVILLE
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:
1316990286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1551 N MILWAUKEE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048-1394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-362-5664
Provider Business Mailing Address Fax Number:
847-362-8829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1551 N MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048-1394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-362-5664
Provider Business Practice Location Address Fax Number:
847-362-8829
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARANI
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
847-362-5664

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  10-7265 , 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: 717060 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com