Provider Demographics
NPI:1528106200
Name:ALHAMBRA AMBULANCE SERVICE FUND
Entity type:Organization
Organization Name:ALHAMBRA AMBULANCE SERVICE FUND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:618-633-2205
Mailing Address - Street 1:401 OLD RTE 66 NORTH
Mailing Address - Street 2:PO BX 261
Mailing Address - City:HAMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62046
Mailing Address - Country:US
Mailing Address - Phone:618-633-2205
Mailing Address - Fax:618-633-2110
Practice Address - Street 1:401 OLD RTE 66 NORTH
Practice Address - Street 2:
Practice Address - City:HAMEL
Practice Address - State:IL
Practice Address - Zip Code:62046
Practice Address - Country:US
Practice Address - Phone:618-633-2205
Practice Address - Fax:618-633-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4 48213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590155602OtherRAIL ROAD MEDICARE
IL=========Medicaid
IL227810Medicare ID - Type Unspecified