Provider Demographics
NPI:1295864403
Name:OPDYKE-BELLE RIVE GRADE SCHOOL
Entity Type:Organization
Organization Name:OPDYKE-BELLE RIVE GRADE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-756-2492
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:OPDYKE
Mailing Address - State:IL
Mailing Address - Zip Code:62872-0189
Mailing Address - Country:US
Mailing Address - Phone:618-756-2492
Mailing Address - Fax:
Practice Address - Street 1:19380 E 4TH STREET
Practice Address - Street 2:
Practice Address - City:OPDYKE
Practice Address - State:IL
Practice Address - Zip Code:62872-0189
Practice Address - Country:US
Practice Address - Phone:618-756-2492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty