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General NPI Number Information
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NPI Number | 1154599165
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Entity Type | Organization
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Legal Business Name | ESWOOD CC GRADE SCH DIST 269
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 304 MAIN ST
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City | LINDENWOOD
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State | IL
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Zip | 61049-7700
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Country | US
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Telephone | 815-393-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 304 MAIN ST
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City | LINDENWOOD
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State | IL
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Zip | 61049-7700
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Country | US
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Telephone | 815-393-4477
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Fax |
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Authorized Official
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Title or Position | SUPER
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Name | DR. DWIGHT MAYBERRY
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Credential |
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Telephone | 815-393-4477
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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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