Healthcare Provider Details

I. General information

NPI: 1861517617
Provider Name (Legal Business Name): BERKELEY SCHOOL DIST 87
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 SAINT CHARLES RD
BERKELEY IL
60163-1244
US

IV. Provider business mailing address

5400 SAINT CHARLES RD
BERKELEY IL
60163-1244
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-2157
  • Fax: 708-450-1116
Mailing address:
  • Phone: 708-450-2157
  • Fax: 708-450-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE SPATAFORE
Title or Position: COORDINATOR
Credential:
Phone: 708-450-2157