Provider Demographics
NPI:1174686992
Name:VILLAGE OF LYONS
Entity Type:Organization
Organization Name:VILLAGE OF LYONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-233-1170
Mailing Address - Street 1:PO BOX 438495
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-8495
Mailing Address - Country:US
Mailing Address - Phone:773-233-1170
Mailing Address - Fax:
Practice Address - Street 1:7801 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IL
Practice Address - Zip Code:60534-1216
Practice Address - Country:US
Practice Address - Phone:708-447-8886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL813101341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL611564200OtherDEPT. OF LABOR
ILP00161187OtherRAILROAD RETIREMENT PROV.
IL1670397OtherBC BS PROVIDER NUMBER
IL1670397OtherBC BS PROVIDER NUMBER
ILP00161187OtherRAILROAD RETIREMENT PROV.