MEDICARE: FLOSSMOOR SCHOOL DISTRICT 161

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	:	1396962106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOSSMOOR SCHOOL DISTRICT 161

Provider Business Mailing Address
First Line	:	41 E ELMWOOD DR
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1104
Country	:	US
Telephone Number	:	708-647-7000
Fax Number	:	708-756-1565

Provider Business Practice Location Address
First Line	:	41 E ELMWOOD DR
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-1104
Country	:	US
Telephone Number	:	708-647-7000
Fax Number	:	708-756-1565

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JUDITH GREEN
Credential	:
Telephone Number	:	708-647-7000

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	05/16/2008

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