Provider Demographics
NPI:1023143179
Name:LEMONT BROMBEREK COMBINED SCHOOL DISTRICT 113A
Entity type:Organization
Organization Name:LEMONT BROMBEREK COMBINED SCHOOL DISTRICT 113A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKWITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:630-257-2286
Mailing Address - Street 1:16100 127TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7462
Mailing Address - Country:US
Mailing Address - Phone:630-257-2286
Mailing Address - Fax:
Practice Address - Street 1:16100 127TH ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-7462
Practice Address - Country:US
Practice Address - Phone:630-257-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid