Provider Demographics
NPI:1073551990
Name:VILLAGE OF BERKELEY
Entity Type:Organization
Organization Name:VILLAGE OF BERKELEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KURYLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-202-3402
Mailing Address - Street 1:395 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1508
Mailing Address - Country:US
Mailing Address - Phone:630-903-2381
Mailing Address - Fax:
Practice Address - Street 1:5819 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:IL
Practice Address - Zip Code:60163-1522
Practice Address - Country:US
Practice Address - Phone:708-449-9444
Practice Address - Fax:708-449-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL889183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632188OtherBLUE CROSS BLUE SHIELD
IL590014942OtherMEDICARE RAILROAD
IL=========001Medicaid