Provider Demographics
NPI:1053325324
Name:VILLAGE OF HOFFMAN ESTATES
Entity Type:Organization
Organization Name:VILLAGE OF HOFFMAN ESTATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-882-2138
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:847-577-7967
Practice Address - Street 1:1900 HASSELL RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-2308
Practice Address - Country:US
Practice Address - Phone:847-882-2138
Practice Address - Fax:847-882-2139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL81903416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1670165OtherBCBS
IL590002596OtherRR MEDICARE
IL360243413001Medicaid
IL=========OtherTRICARE NORTH
IL590002596OtherRR MEDICARE
IL=========00OtherOHIO BUREAU WORKER COMP
IL360243413001Medicaid