Provider Demographics
NPI:1720050826
Name:CITY OF ROCKFORD
Entity type:Organization
Organization Name:CITY OF ROCKFORD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRONOVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-987-5663
Mailing Address - Street 1:PO BOX 8750
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-8750
Mailing Address - Country:US
Mailing Address - Phone:937-424-3701
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:204 S 1ST ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2033
Practice Address - Country:US
Practice Address - Phone:815-987-5663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL011398341600000X
IL3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10115151OtherANTHEM
IL590009290OtherRAILROAD MEDICARE
IL10115151OtherANTHEM
IL590009290OtherRAILROAD MEDICARE