Healthcare Provider Details

I. General information

NPI: 1801949060
Provider Name (Legal Business Name): NEWARK GRADE SCHOOL #66
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CHICAGO RD
NEWARK IL
60541-9501
US

IV. Provider business mailing address

503 CHICAGO RD
NEWARK IL
60541-9501
US

V. Phone/Fax

Practice location:
  • Phone: 815-695-5143
  • Fax: 815-695-5776
Mailing address:
  • Phone: 815-695-5143
  • Fax: 815-695-5776

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: MR. JOHN DEMAY
Title or Position: SUPERINTENDENT
Credential:
Phone: 815-695-5143