Healthcare Provider Details

I. General information

NPI: 1205852639
Provider Name (Legal Business Name): VILLAGE OF CRETE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W EXCHANGE ST
CRETE IL
60417-2139
US

IV. Provider business mailing address

PO BOX 1053
MOKENA IL
60448-2052
US

V. Phone/Fax

Practice location:
  • Phone: 708-672-5431
  • Fax: 708-672-3920
Mailing address:
  • Phone: 708-478-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number7314
License Number StateIL

VIII. Authorized Official

Name: MICHAEL WATERMAN
Title or Position: FIRE CHIEF
Credential:
Phone: 708-672-5431