MEDICARE: COMMUNITY CONSOLIDATED SCHOOL DISTRICT 168

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	:	1497956395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CONSOLIDATED SCHOOL DISTRICT 168

Provider Business Mailing Address
First Line	:	1825 215TH PLACE
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 215TH PLACE
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411
Country	:	US
Telephone Number	:	708-758-1610
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	SARAH JONSON MILLON
Credential	:
Telephone Number	:	708-758-1610

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	08/22/2020

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