Provider Demographics
NPI:1114133246
Name:CITY OF AURORA ILLINOIS
Entity type:Organization
Organization Name:CITY OF AURORA ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-256-3501
Mailing Address - Street 1:44 E DOWNER PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-3302
Mailing Address - Country:US
Mailing Address - Phone:630-256-3501
Mailing Address - Fax:336-791-0196
Practice Address - Street 1:44 E DOWNER PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-3302
Practice Address - Country:US
Practice Address - Phone:630-256-3501
Practice Address - Fax:336-791-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1771491341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========OtherHEALTH NET FEDERAL SVC
IL=========001Medicaid