MEDICARE: BERKELEY SCHOOL DIST 87

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	:	1861517617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERKELEY SCHOOL DIST 87

Provider Business Mailing Address
First Line	:	5400 SAINT CHARLES RD
Second Line	:
City	:	BERKELEY
State	:	IL
Zip	:	60163-1244
Country	:	US
Telephone Number	:	708-450-2157
Fax Number	:	708-450-1116

Provider Business Practice Location Address
First Line	:	5400 SAINT CHARLES RD
Second Line	:
City	:	BERKELEY
State	:	IL
Zip	:	60163-1244
Country	:	US
Telephone Number	:	708-450-2157
Fax Number	:	708-450-1116

Authorized Official
Title or Position	:	COORDINATOR
Name	:	NICOLE SPATAFORE
Credential	:
Telephone Number	:	708-450-2157

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	03/14/2016

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Directions to “BERKELEY SCHOOL DIST 87 ” Practice Location

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