Provider Demographics
NPI:1295764298
Name:VILLAGE OF ROSEMONT ILLINOIS
Entity type:Organization
Organization Name:VILLAGE OF ROSEMONT ILLINOIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:CALMEYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-825-4404
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:630-903-2381
Mailing Address - Fax:
Practice Address - Street 1:9501 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-4811
Practice Address - Country:US
Practice Address - Phone:847-823-1134
Practice Address - Fax:847-823-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL80793416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1670430OtherBCBS
IL590004137OtherRR MEDICARE
IL=========OtherTRICARE NORTH
IL=========001Medicaid
IL=========OtherTRICARE NORTH