Provider Demographics
NPI:1659392850
Name:VILLAGE OF GLENCOE
Entity Type:Organization
Organization Name:VILLAGE OF GLENCOE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC SAFETY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWANDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-461-1132
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:630-530-1280
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:675 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1609
Practice Address - Country:US
Practice Address - Phone:847-835-4112
Practice Address - Fax:847-835-8438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1089153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-19842OtherBLUE CROSS BLUE SHIELD
IL590011314OtherRAILROAD MEDICARE
IL366085899001Medicaid
IL360150Medicare ID - Type UnspecifiedPART B