Healthcare Provider Details

I. General information

NPI: 1447202627
Provider Name (Legal Business Name): VILLAGE OF NORTH RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 DESPLAINES AVE
NORTH RIVERSIDE IL
60546-1564
US

IV. Provider business mailing address

2401 DESPLAINES AVE
NORTH RIVERSIDE IL
60546-1584
US

V. Phone/Fax

Practice location:
  • Phone: 708-447-1981
  • Fax: 708-447-3030
Mailing address:
  • Phone: 708-447-4211
  • Fax: 708-447-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number8829402
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number8829403
License Number StateIL

VIII. Authorized Official

Name: MS. SUSAN SCARPINITI
Title or Position: TREASURER
Credential:
Phone: 708-447-4211