MEDICARE: LEYDEN FIRE PROTECTION DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1114792074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEYDEN FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	2600 MANNHEIM RD
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-3137
Country	:	US
Telephone Number	:	847-455-0180
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 MANNHEIM RD
Second Line	:
City	:	FRANKLIN PARK
State	:	IL
Zip	:	60131-3137
Country	:	US
Telephone Number	:	847-455-0180
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	DR. BRENDA KAY FARLOW
Credential	:
Telephone Number	:	847-455-0180

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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