Provider Demographics
NPI:1750559787
Name:HARLEM SCHOOL DIST 122
Entity type:Organization
Organization Name:HARLEM SCHOOL DIST 122
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYBIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-654-4500
Mailing Address - Street 1:8605 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-2003
Mailing Address - Country:US
Mailing Address - Phone:815-654-4500
Mailing Address - Fax:
Practice Address - Street 1:8605 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-2003
Practice Address - Country:US
Practice Address - Phone:815-654-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
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=========001Medicaid