Provider Demographics
NPI:1114105103
Name:LARAWAY CCSD #70C
Entity Type:Organization
Organization Name:LARAWAY CCSD #70C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:HESBOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-727-5115
Mailing Address - Street 1:275 W LARAWAY RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-9544
Mailing Address - Country:US
Mailing Address - Phone:815-727-5115
Mailing Address - Fax:815-727-5289
Practice Address - Street 1:275 W LARAWAY RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436-9544
Practice Address - Country:US
Practice Address - Phone:815-727-5115
Practice Address - Fax:815-727-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001OtherHFS PROVIDER