Basic Information
| Provider Information | |||||||||
| NPI: | 1619922382 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHERRY VALLEY FIRE PROTECTION DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 W LAKE ST | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601261508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309031280 | ||||||||
| FaxNumber: | 6309032830 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | CHERRY VALLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153325382 | ||||||||
| FaxNumber: | 8153323159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | CORL | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | FIRE CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8153325382 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 11013 | IL | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 214125 | 01 | IL | MEDICARE, PART B | OTHER | 10132209 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER |