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General NPI Number Information
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NPI Number | 1043488554
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Entity Type | Organization
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Legal Business Name | CRESTON COMM SCHOOL
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 202 W SOUTH STREET
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City | ROCHELLE
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State | IL
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Zip | 61068
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Country | US
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Telephone | 815-382-3920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | CRESTON
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State | IL
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Zip | 60113-0037
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Country | US
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Telephone | 815-382-3920
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Fax |
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Authorized Official
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Title or Position | MEDICAID ADMIN
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Name | KAREN COLLINS
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Credential |
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Telephone | 815-382-3920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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