Provider Demographics
NPI:1043484074
Name:GRUNDY KENDALL REGIONAL OFFICE OF EDUCAION
Entity Type:Organization
Organization Name:GRUNDY KENDALL REGIONAL OFFICE OF EDUCAION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-941-3247
Mailing Address - Street 1:1320 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-2426
Mailing Address - Country:US
Mailing Address - Phone:815-941-3247
Mailing Address - Fax:
Practice Address - Street 1:1320 UNION ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-2426
Practice Address - Country:US
Practice Address - Phone:815-941-3247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2100002246056001Medicaid