Healthcare Provider Details

I. General information

NPI: 1043374481
Provider Name (Legal Business Name): VILLAGE OF RICHTON PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 SAUK TRL
RICHTON PARK IL
60471-1126
US

IV. Provider business mailing address

PO BOX 1053
MOKENA IL
60448-2052
US

V. Phone/Fax

Practice location:
  • Phone: 773-233-1170
  • Fax: 773-233-8146
Mailing address:
  • Phone: 708-478-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number891001
License Number StateIL

VIII. Authorized Official

Name: MR. RODNEY WILSON
Title or Position: FIRE CHIEF
Credential: PARAMEDIC
Phone: 708-478-5694