Provider Demographics
NPI:1003376856
Name:CITY OF LOVES PARK
Entity Type:Organization
Organization Name:CITY OF LOVES PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILTFANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-654-5049
Mailing Address - Street 1:400 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4513
Mailing Address - Country:US
Mailing Address - Phone:815-654-5049
Mailing Address - Fax:
Practice Address - Street 1:400 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4513
Practice Address - Country:US
Practice Address - Phone:815-654-5049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance