MEDICARE: NORTH PALOS SCHOOL DIST 117

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1093846180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PALOS SCHOOL DIST 117

Provider Business Mailing Address
First Line	:	9045 S 88TH AVE
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-1252
Country	:	US
Telephone Number	:	708-598-5500
Fax Number	:	708-430-6525

Provider Business Practice Location Address
First Line	:	9045 S 88TH AVE
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-1252
Country	:	US
Telephone Number	:	708-598-5500
Fax Number	:	708-430-6525

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	ETHEL ANGELOS
Credential	:
Telephone Number	:	708-598-5500

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	03/15/2016

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