MEDICARE: UNION RIDGE DISTRICT 86

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	:	1952427023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION RIDGE DISTRICT 86

Provider Business Mailing Address
First Line	:	4600 N OAK PARK AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4823
Country	:	US
Telephone Number	:	708-867-5822
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 N OAK PARK AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4823
Country	:	US
Telephone Number	:	708-867-5822
Fax Number	:

Authorized Official
Title or Position	:	INTERIM SUPERINTENDENT
Name	:	RAYMOND J. KUPER
Credential	:	ED.D
Telephone Number	:	708-867-5822

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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