Provider Demographics
NPI:1578944344
Name:PROVISO AREA EXCEPTIONAL CHILD
Entity Type:Organization
Organization Name:PROVISO AREA EXCEPTIONAL CHILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-450-2157
Mailing Address - Street 1:1000 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1970
Mailing Address - Country:US
Mailing Address - Phone:708-450-2157
Mailing Address - Fax:
Practice Address - Street 1:1000 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1970
Practice Address - Country:US
Practice Address - Phone:708-450-2157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)