Healthcare Provider Details

I. General information

NPI: 1437176385
Provider Name (Legal Business Name): VILLAGE OF DOWNERS GROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BURLINGTON AVE
DOWNERS GROVE IL
60515-4782
US

IV. Provider business mailing address

PO BOX 457
WHEELING IL
60090-0457
US

V. Phone/Fax

Practice location:
  • Phone: 630-434-5980
  • Fax: 630-434-5998
Mailing address:
  • Phone: 847-577-8811
  • Fax: 847-577-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number7212
License Number StateIL

VIII. Authorized Official

Name: PHIL RUSCETTI
Title or Position: FIRE CHIEF
Credential:
Phone: 630-434-5990