Provider Demographics
NPI:1447385257
Name:VILLAGE OF NORTHBROOK
Entity Type:Organization
Organization Name:VILLAGE OF NORTHBROOK
Other - Org Name:NORTHBROOK FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN CLERK
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-664-4494
Mailing Address - Street 1:740 DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2704
Mailing Address - Country:US
Mailing Address - Phone:847-272-2141
Mailing Address - Fax:847-272-3294
Practice Address - Street 1:740 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-272-2141
Practice Address - Fax:847-272-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL8192341600000X
IL10 81923416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001619793OtherBLUE CROSS BLUE SHIELD
IL0001619793OtherBLUE CROSS BLUE SHIELD
IL997680Medicare ID - Type Unspecified