Provider Demographics
NPI:1104811967
Name:VILLAGE OF BOLINGBROOK ILLINOIS
Entity type:Organization
Organization Name:VILLAGE OF BOLINGBROOK ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:LAJOIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-226-8540
Mailing Address - Street 1:395 WEST LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1508
Mailing Address - Country:US
Mailing Address - Phone:630-903-2372
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:375 W BRIARCLIFF RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3825
Practice Address - Country:US
Practice Address - Phone:630-226-8540
Practice Address - Fax:630-759-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9915055OtherBCBS OF IL
590005580OtherRAILROAD MEDICARE
309120Medicare ID - Type Unspecified
IL9915055OtherBCBS OF IL