Healthcare Provider Details

I. General information

NPI: 1972533081
Provider Name (Legal Business Name): VILLAGE OF RIVER GROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 THATCHER
RIVER GROVE IL
60171
US

IV. Provider business mailing address

2601 THATCHER
RIVER GROVE IL
60171
US

V. Phone/Fax

Practice location:
  • Phone: 708-453-1429
  • Fax: 708-453-8154
Mailing address:
  • Phone: 708-453-1429
  • Fax: 708-453-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number88077
License Number StateIL

VIII. Authorized Official

Name: LARRY G LARIVIRE
Title or Position: FIRE CHIEF
Credential:
Phone: 708-453-1429