Healthcare Provider Details

I. General information

NPI: 1265667224
Provider Name (Legal Business Name): HOLLYWOOD HEIGHTS FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 HOLLYWOOD HEIGHTS RD
CASEYVILLE IL
62232-1128
US

IV. Provider business mailing address

PO BOX 457
WHEELING IL
60090-0457
US

V. Phone/Fax

Practice location:
  • Phone: 618-345-8889
  • Fax: 618-345-7048
Mailing address:
  • Phone: 847-577-8811
  • Fax: 847-577-3518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License NumberNONE
License Number StateIL

VIII. Authorized Official

Name: EARL MOORE
Title or Position: FIRE CHIEF
Credential:
Phone: 618-345-8889