Provider Demographics
NPI:1063792141
Name:ODIN PUBLIC SCHOOL DISTRICT 722
Entity type:Organization
Organization Name:ODIN PUBLIC SCHOOL DISTRICT 722
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-775-8266
Mailing Address - Street 1:102 S MERRITT ST
Mailing Address - Street 2:
Mailing Address - City:ODIN
Mailing Address - State:IL
Mailing Address - Zip Code:62870-1112
Mailing Address - Country:US
Mailing Address - Phone:618-775-8266
Mailing Address - Fax:618-775-8268
Practice Address - Street 1:102 S MERRITT ST
Practice Address - Street 2:
Practice Address - City:ODIN
Practice Address - State:IL
Practice Address - Zip Code:62870-1112
Practice Address - Country:US
Practice Address - Phone:618-775-8266
Practice Address - Fax:618-775-8268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376003879001Medicaid
IL376003909001Medicaid