Healthcare Provider Details

I. General information

NPI: 1881929537
Provider Name (Legal Business Name): VILLAGE OF WESTERN SPRG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 WOLF RD
WESTERN SPRGS IL
60558-1416
US

IV. Provider business mailing address

740 HILLGROVE AVE
WESTERN SPRGS IL
60558-1409
US

V. Phone/Fax

Practice location:
  • Phone: 708-246-1182
  • Fax: 708-246-4871
Mailing address:
  • Phone: 708-246-1182
  • Fax: 708-246-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number08 8084
License Number StateIL

VIII. Authorized Official

Name: MS. DONNA M RUCH
Title or Position: PARAMEDIC FIREFIGHTER
Credential:
Phone: 708-246-1182