Healthcare Provider Details

I. General information

NPI: 1376596148
Provider Name (Legal Business Name): CITY OF HIGHWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 GREEN BAY RD
HIGHWOOD IL
60040-1306
US

IV. Provider business mailing address

395 W LAKE ST
ELMHURST IL
60126-1508
US

V. Phone/Fax

Practice location:
  • Phone: 847-432-7622
  • Fax: 847-432-7521
Mailing address:
  • Phone: 630-903-1280
  • Fax: 630-903-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number107917
License Number StateIL

VIII. Authorized Official

Name: MR. THOMAS LOVEJOY
Title or Position: FIRE CHIEF
Credential:
Phone: 847-432-7622