Healthcare Provider Details

I. General information

NPI: 1336204841
Provider Name (Legal Business Name): VILLAGE OF STICKNEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6433 43RD ST
STICKNEY IL
60402-4417
US

IV. Provider business mailing address

PO BOX 1368
ELMHURST IL
60126-8368
US

V. Phone/Fax

Practice location:
  • Phone: 773-233-1170
  • Fax: 773-233-8146
Mailing address:
  • Phone: 630-530-2988
  • Fax: 630-832-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEFFREY GLENN BOYAJIAN
Title or Position: FIRE CHIEF
Credential:
Phone: 708-795-6333