Provider Demographics
NPI:1205859659
Name:VILLAGE OF FOREST PARK
Entity Type:Organization
Organization Name:VILLAGE OF FOREST PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMSTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-615-6208
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:630-903-2381
Mailing Address - Fax:
Practice Address - Street 1:517 DES PLAINES AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1801
Practice Address - Country:US
Practice Address - Phone:708-615-6208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL8059341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1670960OtherBCBS
IL590014285OtherRR MEDICARE
IL1670960OtherBCBS
IL916470Medicare PIN