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General NPI Number Information
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NPI Number | 1770614877
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Entity Type | Organization
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Legal Business Name | DIAMOND LAKE SCH DIST 76
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 25807 N DIAMOND LAKE RD
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City | MUNDELEIN
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State | IL
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Zip | 60060-9415
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Country | US
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Telephone | 847-566-9221
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Fax | 847-566-5689
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Provider Business Mailing Address
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Address Line | 25807 N DIAMOND LAKE RD
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City | MUNDELEIN
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State | IL
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Zip | 60060-9415
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Country | US
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Telephone | 847-566-9221
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Fax | 847-566-5689
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | COLETTE FORD
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Credential |
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Telephone | 847-566-9221
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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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