Healthcare Provider Details

I. General information

NPI: 1720050826
Provider Name (Legal Business Name): CITY OF ROCKFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S 1ST ST
ROCKFORD IL
61104-2033
US

IV. Provider business mailing address

PO BOX 8750
CAROL STREAM IL
60197-8750
US

V. Phone/Fax

Practice location:
  • Phone: 815-987-5663
  • Fax:
Mailing address:
  • Phone: 937-424-3701
  • Fax: 937-291-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number011398
License Number StateIL

VIII. Authorized Official

Name: GREG CASTRONOVO
Title or Position: CHIEF
Credential:
Phone: 815-987-5663