Provider Demographics
NPI:1881929537
Name:VILLAGE OF WESTERN SPRG
Entity type:Organization
Organization Name:VILLAGE OF WESTERN SPRG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARAMEDIC FIREFIGHTER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-246-1182
Mailing Address - Street 1:740 HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1409
Mailing Address - Country:US
Mailing Address - Phone:708-246-1182
Mailing Address - Fax:708-246-4871
Practice Address - Street 1:4353 WOLF RD
Practice Address - Street 2:
Practice Address - City:WESTERN SPRGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1416
Practice Address - Country:US
Practice Address - Phone:708-246-1182
Practice Address - Fax:708-246-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL08 80843416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport