Provider Demographics
NPI:1073652657
Name:MAINE EAST SCHOOL BASED HEALTH CENTER
Entity Type:Organization
Organization Name:MAINE EAST SCHOOL BASED HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST SUPERINTENDANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-692-8025
Mailing Address - Street 1:2601 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1155
Mailing Address - Country:US
Mailing Address - Phone:847-825-4058
Mailing Address - Fax:847-825-4060
Practice Address - Street 1:2601 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1155
Practice Address - Country:US
Practice Address - Phone:847-825-4058
Practice Address - Fax:847-825-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health