1003931858 NPI number — BELLWOOD SCHOOL DIST 88

Table of content: ARLENE MAIRE SAMEN APRN (NPI 1437864683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003931858 NPI number — BELLWOOD SCHOOL DIST 88

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLWOOD SCHOOL DIST 88
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003931858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 N 36TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONE PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60165-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-450-2157
Provider Business Mailing Address Fax Number:
708-450-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N 36TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STONE PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60165-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-450-2157
Provider Business Practice Location Address Fax Number:
708-450-1116
Provider Enumeration Date:
03/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDRICKS
Authorized Official First Name:
ROSEMARY
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
708-450-2157

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)