Provider Demographics
NPI:1144236951
Name:VILLAGE OF MORTON GROVE
Entity Type:Organization
Organization Name:VILLAGE OF MORTON GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-470-5226
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:630-903-2372
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:6250 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2852
Practice Address - Country:US
Practice Address - Phone:847-470-5226
Practice Address - Fax:847-965-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1081883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-70646OtherBCBS
IL590013814OtherRAILROAD MEDICARE
IL590013814OtherRAILROAD MEDICARE
IL=========001Medicaid