Provider Demographics
NPI:1518002740
Name:BLOOM TOWNSHIP SCHOOL DISTRICT 206
Entity Type:Organization
Organization Name:BLOOM TOWNSHIP SCHOOL DISTRICT 206
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT-BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:708-755-7010
Mailing Address - Street 1:100 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-2002
Mailing Address - Country:US
Mailing Address - Phone:708-755-7010
Mailing Address - Fax:
Practice Address - Street 1:100 W 10TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2002
Practice Address - Country:US
Practice Address - Phone:708-755-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
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=========007Medicaid