1689810046 NPI number — SCHOOL DISTRICT 64 PARK RIDGE/NILES, IL

Table of content: (NPI 1689810046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689810046 NPI number — SCHOOL DISTRICT 64 PARK RIDGE/NILES, IL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHOOL DISTRICT 64 PARK RIDGE/NILES, IL
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:
1689810046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8101 N CUMBERLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NILES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60714-2736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-318-8713
Provider Business Mailing Address Fax Number:
847-318-8701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1731 PAVILION WAY UNIT 207
Provider Second Line Business Practice Location Address:
#207
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60068-1190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-899-8284
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOGIL
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL OF EMERSON MIDDLE SCHOOL
Authorized Official Telephone Number:
18473188110

Provider Taxonomy Codes

  • Taxonomy code: 1041S0200X , with the licence number:  150005062 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 150005062 . This is a "STATE OF ILLINOIS DEPT. OF REGISTRATION SOCIAL WORK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".