Healthcare Provider Details

I. General information

NPI: 1942397013
Provider Name (Legal Business Name): VILLAGE OF SKOKIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 OAKTON ST
SKOKIE IL
60077
US

IV. Provider business mailing address

PO BOX 6275
CAROL STREAM IL
60197-6275
US

V. Phone/Fax

Practice location:
  • Phone: 847-982-5320
  • Fax: 847-675-2318
Mailing address:
  • Phone: 708-478-5694
  • Fax: 708-478-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number108198
License Number StateIL

VIII. Authorized Official

Name: MR. RALPH CZERWINSKI
Title or Position: FIRE CHIEF
Credential:
Phone: 847-982-5320