Provider Demographics
NPI:1114195583
Name:VILLAGE OF ELK GROVE VILLAGE
Entity Type:Organization
Organization Name:VILLAGE OF ELK GROVE VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH & COMMUNITY SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAVALLINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-357-4242
Mailing Address - Street 1:901 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3456
Mailing Address - Country:US
Mailing Address - Phone:847-357-4240
Mailing Address - Fax:847-357-4250
Practice Address - Street 1:901 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3456
Practice Address - Country:US
Practice Address - Phone:847-357-4240
Practice Address - Fax:847-357-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN