Provider Demographics
NPI:1710924253
Name:CAROL STREAM FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:CAROL STREAM FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BODANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-668-4836
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:847-577-9515
Practice Address - Street 1:365 KUHN RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-4707
Practice Address - Country:US
Practice Address - Phone:630-668-4836
Practice Address - Fax:630-668-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL72543416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2221561OtherBLUE CROSS BLUE SHIELD
IL2221561OtherBLUE CROSS BLUE SHIELD
IL=========OtherHEALTH NET FEDERAL SVC
IL418740Medicare PIN