MEDICARE: BEACH PARK CONS SCHOOL DIST 3

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	:	1770614851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH PARK CONS SCHOOL DIST 3

Provider Business Mailing Address
First Line	:	11315 W WADSWORTH RD
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60099-3359
Country	:	US
Telephone Number	:	847-599-5006
Fax Number	:	847-360-1130

Provider Business Practice Location Address
First Line	:	11315 W WADSWORTH RD
Second Line	:
City	:	BEACH PARK
State	:	IL
Zip	:	60099-3359
Country	:	US
Telephone Number	:	847-599-5006
Fax Number	:	847-360-1130

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ASTRID MARTINDALE
Credential	:
Telephone Number	:	847-599-5056

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	05/15/2008

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Directions to “BEACH PARK CONS SCHOOL DIST 3 ” Practice Location

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