MEDICARE: NEWARK COMMUNITY HIGH SCHOOL #18

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	:	1659424802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWARK COMMUNITY HIGH SCHOOL #18

Provider Business Mailing Address
First Line	:	413 CHICAGO RD
Second Line	:
City	:	NEWARK
State	:	IL
Zip	:	60541-8900
Country	:	US
Telephone Number	:	815-695-5164
Fax Number	:	815-695-5752

Provider Business Practice Location Address
First Line	:	413 CHICAGO RD
Second Line	:
City	:	NEWARK
State	:	IL
Zip	:	60541-8900
Country	:	US
Telephone Number	:	815-695-5164
Fax Number	:	815-695-5752

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MRS. PAULINE BERGGREN
Credential	:
Telephone Number	:	815-695-5164

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/22/2020

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