Provider Demographics
NPI:1104257161
Name:VILLAGE OF DOLTON
Entity type:Organization
Organization Name:VILLAGE OF DOLTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-201-3250
Mailing Address - Street 1:14022 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1029
Mailing Address - Country:US
Mailing Address - Phone:708-849-2145
Mailing Address - Fax:708-841-2863
Practice Address - Street 1:14022 PARK AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1029
Practice Address - Country:US
Practice Address - Phone:708-849-2145
Practice Address - Fax:708-841-2863
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE OF DOLTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03-04-1625341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance