Provider Demographics
NPI:1598716714
Name:VILLAGE OF HILLSIDE
Entity Type:Organization
Organization Name:VILLAGE OF HILLSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LOIUS
Authorized Official - Last Name:CARLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-202-3402
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:630-903-2372
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:523 N WOLF RD
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-1209
Practice Address - Country:US
Practice Address - Phone:708-202-3402
Practice Address - Fax:708-544-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL880633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-21242OtherBLUECROSSBLUESHIELD
IL590013947OtherRAILROAD MEDICARE
IL=========001Medicaid
IL=========001Medicaid