Provider Demographics
NPI:1417073578
Name:RIVER GROVE SCHOOL DISTRICT 85.5
Entity Type:Organization
Organization Name:RIVER GROVE SCHOOL DISTRICT 85.5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-453-6172
Mailing Address - Street 1:2650 THATCHER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1650
Mailing Address - Country:US
Mailing Address - Phone:708-453-6172
Mailing Address - Fax:
Practice Address - Street 1:2650 THATCHER AVE
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1650
Practice Address - Country:US
Practice Address - Phone:708-453-6172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid