Provider Demographics
NPI:1316015704
Name:HOPEDALE FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:HOPEDALE FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CO-ORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-208-3663
Mailing Address - Street 1:226 NW MAIN
Mailing Address - Street 2:
Mailing Address - City:HOPEDALE
Mailing Address - State:IL
Mailing Address - Zip Code:61747-9478
Mailing Address - Country:US
Mailing Address - Phone:309-449-5435
Mailing Address - Fax:309-449-5435
Practice Address - Street 1:226 NW MAIN
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:IL
Practice Address - Zip Code:61747-9478
Practice Address - Country:US
Practice Address - Phone:309-208-3663
Practice Address - Fax:309-449-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225393416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL009032125OtherBLUE CROSS BLUE SHIELD
IL009032125OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid