Healthcare Provider Details

I. General information

NPI: 1750583217
Provider Name (Legal Business Name): SPRING VALLEY CC SCH DIST 99
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N RICHARDS ST
SPRING VALLEY IL
61362-1238
US

IV. Provider business mailing address

800 N RICHARDS ST
SPRING VALLEY IL
61362-1238
US

V. Phone/Fax

Practice location:
  • Phone: 815-875-2645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GWEN GARVER
Title or Position: DIRECTOR
Credential:
Phone: 815-875-2645