Provider Demographics
NPI:1083786339
Name:VILLAGE OF SKOKIE
Entity Type:Organization
Organization Name:VILLAGE OF SKOKIE
Other - Org Name:SKOKIE HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUCKLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:847-933-8252
Mailing Address - Street 1:5127 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3633
Mailing Address - Country:US
Mailing Address - Phone:847-933-8252
Mailing Address - Fax:847-673-8606
Practice Address - Street 1:5127 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3633
Practice Address - Country:US
Practice Address - Phone:847-933-8252
Practice Address - Fax:847-673-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL333750Medicare ID - Type UnspecifiedMEDICARE PROVIDER