Provider Demographics
NPI:1639393184
Name:VILLAGE OF LAKEWOOD
Entity Type:Organization
Organization Name:VILLAGE OF LAKEWOOD
Other - Org Name:LAKEWOOD FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-459-3025
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-3518
Practice Address - Street 1:2500 LAKE AVE
Practice Address - Street 2:
Practice Address - City:VILLAGE OF LAKEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60014-5120
Practice Address - Country:US
Practice Address - Phone:815-459-3025
Practice Address - Fax:815-459-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL82053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5632233OtherBCBS
IL=========001Medicaid
IL=========001Medicaid