Provider Demographics
NPI:1629115027
Name:GRANT COMMUNITY HIGH SCHOOL DISTRICT 124
Entity Type:Organization
Organization Name:GRANT COMMUNITY HIGH SCHOOL DISTRICT 124
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEFCIK
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:847-587-2561
Mailing Address - Street 1:285 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1634
Mailing Address - Country:US
Mailing Address - Phone:847-587-2561
Mailing Address - Fax:
Practice Address - Street 1:285 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1634
Practice Address - Country:US
Practice Address - Phone:847-587-2561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========001Medicaid