Provider Demographics
NPI:1518005842
Name:PROSPECT HEIGHTS SCHOOL DISTRICT 23
Entity Type:Organization
Organization Name:PROSPECT HEIGHTS SCHOOL DISTRICT 23
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-870-3850
Mailing Address - Street 1:700 N SCHOENBECK RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1231
Mailing Address - Country:US
Mailing Address - Phone:847-870-3850
Mailing Address - Fax:
Practice Address - Street 1:700 N SCHOENBECK RD
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1231
Practice Address - Country:US
Practice Address - Phone:847-870-3850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid