Basic Information
| Provider Information | |||||||||
| NPI: | 1699947044 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SERENA COMMUNITY VOLUNTEER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SERENA COMMUNITY FIRE PROTECTION DISTRICT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 457 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600900457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475778811 | ||||||||
| FaxNumber: | 8475773518 | ||||||||
| Practice Location | |||||||||
| Address1: | 2286 US ROUTE 52 | ||||||||
| Address2: | |||||||||
| City: | SERENA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605495104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154962629 | ||||||||
| FaxNumber: | 8154962428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2008 | ||||||||
| LastUpdateDate: | 09/05/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | REESE | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 8154962629 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333300000X | Y | Suppliers | Emergency Response System Companies |
No ID Information.