Healthcare Provider Details

I. General information

NPI: 1154336865
Provider Name (Legal Business Name): VILLAGE OF LA GRANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W BURLINGTON AVE
LA GRANGE IL
60525-2363
US

IV. Provider business mailing address

PO BOX 457
WHEELING IL
60090-0457
US

V. Phone/Fax

Practice location:
  • Phone: 708-579-2338
  • Fax: 708-579-9747
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 Number8064
License Number StateIL

VIII. Authorized Official

Name: DAVID FLEEGE
Title or Position: FIRE CHIEF
Credential:
Phone: 708-579-2338