Provider Demographics
NPI:1871825661
Name:LIBERTYVILLE SCHOOL DISTRICT #70
Entity Type:Organization
Organization Name:LIBERTYVILLE SCHOOL DISTRICT #70
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:T
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-362-9030
Mailing Address - Street 1:1381 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1729
Mailing Address - Country:US
Mailing Address - Phone:847-362-9030
Mailing Address - Fax:847-362-3003
Practice Address - Street 1:1381 W. LAKE ST.
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1729
Practice Address - Country:US
Practice Address - Phone:847-362-9030
Practice Address - Fax:847-362-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL001251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid