Provider Demographics
NPI:1619133667
Name:ORLAND TOWNSHIP
Entity Type:Organization
Organization Name:ORLAND TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:O'GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-403-4222
Mailing Address - Street 1:14807 S. RAVINIA
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-403-4222
Mailing Address - Fax:708-403-4260
Practice Address - Street 1:14807 S. RAVINIA
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-403-4222
Practice Address - Fax:708-403-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL332480Medicare PIN