Provider Demographics
NPI:1417184987
Name:VILLAGE OF GLEN ELLYN OFFICE OF TREAS
Entity Type:Organization
Organization Name:VILLAGE OF GLEN ELLYN OFFICE OF TREAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VILLAGE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-547-5212
Mailing Address - Street 1:395 WEST LAKE STREET
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 1:524 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4137
Practice Address - Country:US
Practice Address - Phone:630-469-5265
Practice Address - Fax:630-469-1762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2273OtherMEDICARE PART B
IL2234162OtherBCBS
ILIL2273OtherMEDICARE PART B