Healthcare Provider Details

I. General information

NPI: 1730100942
Provider Name (Legal Business Name): VILLAGE OF BROADVIEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 S 25TH AVE
BROADVIEW IL
60155-3827
US

IV. Provider business mailing address

PO BOX 6253
CAROL STREAM IL
60197-6253
US

V. Phone/Fax

Practice location:
  • Phone: 708-343-6124
  • Fax: 708-204-8918
Mailing address:
  • Phone: 630-530-2988
  • Fax: 630-832-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number88055
License Number StateIL

VIII. Authorized Official

Name: MATTHEW J MARTIN
Title or Position: DEPUTY CHIEF
Credential:
Phone: 708-343-6124