MEDICARE: COMMUNITY HIGH SCHOOL DIST 94

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		IL

General Provider Information

NPI Number	:	1043335490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HIGH SCHOOL DIST 94

Provider Business Mailing Address
First Line	:	326 JOLIET ST
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3142
Country	:	US
Telephone Number	:	630-876-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 JOLIET ST
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3142
Country	:	US
Telephone Number	:	630-876-6200
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DR. LEE RIECK
Credential	:
Telephone Number	:	630-876-6200

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/21/2022

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