Provider Demographics
NPI:1710093372
Name:VILLAGE OF GURNEE
Entity Type:Organization
Organization Name:VILLAGE OF GURNEE
Other - Org Name:GURNEE FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOSNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-599-7521
Mailing Address - Street 1:PO BOX 6253
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-6253
Mailing Address - Country:US
Mailing Address - Phone:630-530-2988
Mailing Address - Fax:630-832-9750
Practice Address - Street 1:4580 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2813
Practice Address - Country:US
Practice Address - Phone:847-599-6600
Practice Address - Fax:847-244-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1072673416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04920462OtherBCBS
IL590008355OtherRAILROAD MEDICARE
IL=========001Medicaid
IL04920462OtherBCBS