Provider Demographics
NPI:1033396387
Name:MARENGO-UNION ELEMENTARY CONSOLIDATED SCHOOL DISTRICT 165
Entity Type:Organization
Organization Name:MARENGO-UNION ELEMENTARY CONSOLIDATED SCHOOL DISTRICT 165
Other - Org Name:MARENGO UNION SCHOOL DISTRICT 165
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAMISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-568-8323
Mailing Address - Street 1:816 E GRANT HWY
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-3400
Mailing Address - Country:US
Mailing Address - Phone:815-568-8323
Mailing Address - Fax:815-568-8367
Practice Address - Street 1:816 E GRANT HWY
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IL
Practice Address - Zip Code:60152-3400
Practice Address - Country:US
Practice Address - Phone:815-568-8323
Practice Address - Fax:815-568-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid