Provider Demographics
NPI:1447202627
Name:VILLAGE OF NORTH RIVERSIDE
Entity Type:Organization
Organization Name:VILLAGE OF NORTH RIVERSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARPINITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-447-4211
Mailing Address - Street 1:2401 DESPLAINES AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1584
Mailing Address - Country:US
Mailing Address - Phone:708-447-4211
Mailing Address - Fax:708-447-4292
Practice Address - Street 1:2331 DESPLAINES AVE
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1564
Practice Address - Country:US
Practice Address - Phone:708-447-1981
Practice Address - Fax:708-447-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL8829402341600000X
IL8829403341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021621768OtherBC/BS OF IL
IL=========6054601Medicaid
IL0021621768OtherBC/BS OF IL