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General NPI Number Information
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NPI Number | 1275663262
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Entity Type | Organization
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Legal Business Name | PRAIRIE GROVE SCHOOL DISTRICT
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 3223 ROUTE 176
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014
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Country | US
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Telephone | 815-459-3557
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Fax |
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Provider Business Mailing Address
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Address Line | 3223 ROUTE 176
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014
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Country | US
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Telephone | 815-459-3557
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Fax |
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Authorized Official
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Title or Position | COORDINATOR
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Name | BARB BAILEY
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Credential |
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Telephone | 815-459-3557
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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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