Provider Demographics
NPI:1396800892
Name:VILLAGE OF EVERGREEN PARK
Entity type:Organization
Organization Name:VILLAGE OF EVERGREEN PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-476-3200
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:
Practice Address - Street 1:9000 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1311
Practice Address - Country:US
Practice Address - Phone:773-233-1170
Practice Address - Fax:773-233-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1670314OtherBC BS OF ILLINOIS
IL590001810OtherRAILROAD RETIREMENT
IL1670314OtherHMO ILLINOIS
IL590001810OtherRAILROAD RETIREMENT
IL1670314OtherBC BS OF ILLINOIS