Provider Demographics
NPI:1962512236
Name:NORTHWEST HOMER FIRE PROTECTION
Entity type:Organization
Organization Name:NORTHWEST HOMER FIRE PROTECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLISAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-838-0180
Mailing Address - Street 1:16152 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8595
Mailing Address - Country:US
Mailing Address - Phone:815-838-0180
Mailing Address - Fax:815-838-0185
Practice Address - Street 1:16152 W 143RD ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60491-8595
Practice Address - Country:US
Practice Address - Phone:815-838-0180
Practice Address - Fax:815-838-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL723103341600000X
IL723102341600000X
IL723101341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL499230Medicare ID - Type Unspecified