Healthcare Provider Details

I. General information

NPI: 1225083199
Provider Name (Legal Business Name): MARENGO RESCUE SQUAD DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E PRAIRIE ST
MARENGO IL
60152-3128
US

IV. Provider business mailing address

120 E PRAIRIE ST
MARENGO IL
60152-3128
US

V. Phone/Fax

Practice location:
  • Phone: 815-568-8912
  • Fax: 815-568-8920
Mailing address:
  • Phone: 815-568-8912
  • Fax: 815-568-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1706934
License Number StateIL

VIII. Authorized Official

Name: JODI WIGHTMAN
Title or Position: DEPUTY TREASURER
Credential:
Phone: 815-568-8912