Provider Demographics
NPI:1013185024
Name:EAST DUBUQUE UNIT 119
Entity Type:Organization
Organization Name:EAST DUBUQUE UNIT 119
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-747-3117
Mailing Address - Street 1:200 PARKLANE DR
Mailing Address - Street 2:
Mailing Address - City:EAST DUBUQUE
Mailing Address - State:IL
Mailing Address - Zip Code:61025-9597
Mailing Address - Country:US
Mailing Address - Phone:815-747-3117
Mailing Address - Fax:
Practice Address - Street 1:200 PARKLANE DR
Practice Address - Street 2:
Practice Address - City:EAST DUBUQUE
Practice Address - State:IL
Practice Address - Zip Code:61025-9597
Practice Address - Country:US
Practice Address - Phone:815-747-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid