Provider Demographics
NPI:1265548002
Name:VILLAGE OF BELLWOOD
Entity type:Organization
Organization Name:VILLAGE OF BELLWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-547-3524
Mailing Address - Street 1:395 WEST LAKE STREET
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:630-530-2988
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:3200 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-1950
Practice Address - Country:US
Practice Address - Phone:708-547-3524
Practice Address - Fax:708-547-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL880603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL590013125OtherRAILROAD MEDICARE
IL01620456OtherBCBS
IL590013125OtherRAILROAD MEDICARE
IL=========001OtherPUBLIC AID