Provider Demographics
NPI:1639357536
Name:LAGRANGE HIGHLANDS SD 106
Entity Type:Organization
Organization Name:LAGRANGE HIGHLANDS SD 106
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKENMAIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-246-3085
Mailing Address - Street 1:1750 W PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-3727
Mailing Address - Country:US
Mailing Address - Phone:708-246-3085
Mailing Address - Fax:708-246-0220
Practice Address - Street 1:1750 W PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-3727
Practice Address - Country:US
Practice Address - Phone:708-246-3085
Practice Address - Fax:708-246-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001OtherILLINOIS HFS PROVIDER NUM