MEDICARE: NILES TOWNSHIP HS DI

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)

General Provider Information

NPI Number	:	1467580068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NILES TOWNSHIP HS DI

Provider Business Mailing Address
First Line	:	7700 GROSS POINT RD
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-2614
Country	:	US
Telephone Number	:	847-626-3990
Fax Number	:	847-686-3077

Provider Business Practice Location Address
First Line	:	7700 GROSS POINT RD
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-2614
Country	:	US
Telephone Number	:	847-626-3990
Fax Number	:	847-686-3077

Authorized Official
Title or Position	:	ASST SUPT
Name	:	PETE MARCELO
Credential	:
Telephone Number	:	847-686-3990

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	03/15/2016

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