Healthcare Provider Details

I. General information

NPI: 1851326201
Provider Name (Legal Business Name): VILLAGE OF WESTERN SPRINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 WOLF RD.
WESTERN SPRINGS IL
60558-1416
US

IV. Provider business mailing address

4353 WOLF RD.
WESTERN SPRINGS IL
60558-1416
US

V. Phone/Fax

Practice location:
  • Phone: 708-246-1800
  • Fax: 708-246-4871
Mailing address:
  • Phone: 708-246-1800
  • Fax: 708-246-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number8084
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateIL

VIII. Authorized Official

Name: PATRICK KENNY
Title or Position: FIRE CHIEF
Credential:
Phone: 708-246-1800