MEDICARE: DOWNERS GROVE GRDE SCH DIST 58

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)		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972637288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOWNERS GROVE GRDE SCH DIST 58

Provider Business Mailing Address
First Line	:	1860 63RD ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-2471
Country	:	US
Telephone Number	:	630-719-5800
Fax Number	:	630-719-9857

Provider Business Practice Location Address
First Line	:	1860 63RD ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-2471
Country	:	US
Telephone Number	:	630-719-5800
Fax Number	:	630-719-9857

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DR. DALE MARTIN
Credential	:
Telephone Number	:	630-719-5800

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/21/2022

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