Provider Demographics
NPI:1124196795
Name:MT HOPE FUNKS GROVE FIRE PROTECTION
Entity Type:Organization
Organization Name:MT HOPE FUNKS GROVE FIRE PROTECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-874-2532
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:IL
Mailing Address - Zip Code:61754-0169
Mailing Address - Country:US
Mailing Address - Phone:309-874-2532
Mailing Address - Fax:309-874-2096
Practice Address - Street 1:209 SOUTH HAMILTON ST
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:IL
Practice Address - Zip Code:61754
Practice Address - Country:US
Practice Address - Phone:309-874-2532
Practice Address - Fax:309-874-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL204404Medicare PIN