Provider Demographics
NPI:1225378094
Name:KANKAKEE SCHOOL DISTRICT 111
Entity Type:Organization
Organization Name:KANKAKEE SCHOOL DISTRICT 111
Other - Org Name:KHS SCHOOL-BASED HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-802-7752
Mailing Address - Street 1:1200 W JEFFERY ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-4667
Mailing Address - Country:US
Mailing Address - Phone:815-933-0690
Mailing Address - Fax:815-933-6704
Practice Address - Street 1:1200 W JEFFERY ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-4667
Practice Address - Country:US
Practice Address - Phone:815-933-0690
Practice Address - Fax:815-933-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health