1962425090 NPI number — TOWN OF CEDAR LAKE

Table of content: (NPI 1962425090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962425090 NPI number — TOWN OF CEDAR LAKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF CEDAR 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:
1962425090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 707
Provider Second Line Business Mailing Address:
7408 CONSTITUTION AVENUE
Provider Business Mailing Address City Name:
CEDAR LAKE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46303-0707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-374-7000
Provider Business Mailing Address Fax Number:
219-374-4446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9430 W. 133RD AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR LAKE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46303-0459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-374-5961
Provider Business Practice Location Address Fax Number:
219-374-5999
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILKENING
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
219-374-5961

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100281690A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 978580 . This is a "MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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