Provider Demographics
NPI:1992824924
Name:FORRESTON FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:FORRESTON FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:ROYCE
Authorized Official - Last Name:DAWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-262-3531
Mailing Address - Street 1:P.O. BOX 260
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-0260
Mailing Address - Country:US
Mailing Address - Phone:815-539-2468
Mailing Address - Fax:815-539-6427
Practice Address - Street 1:301 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:FORRESTON
Practice Address - State:IL
Practice Address - Zip Code:61030-0212
Practice Address - Country:US
Practice Address - Phone:815-938-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13696883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07132001OtherBCBS OF IL PROVIDER
IL=========001Medicaid
IL=========001Medicaid