Provider Demographics
NPI:1548355670
Name:LEAF RIVER FIRE PROTECTION DIST.
Entity type:Organization
Organization Name:LEAF RIVER FIRE PROTECTION DIST.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-494-9197
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:LEAF RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:61047-0248
Mailing Address - Country:US
Mailing Address - Phone:815-738-2219
Mailing Address - Fax:
Practice Address - Street 1:205 W THIRD ST
Practice Address - Street 2:
Practice Address - City:LEAF RIVER
Practice Address - State:IL
Practice Address - Zip Code:61047-4503
Practice Address - Country:US
Practice Address - Phone:815-738-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135901341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL767980Medicare ID - Type UnspecifiedAMBULANCE SERVICE