Provider Demographics
NPI:1104941186
Name:PONTIAC TWP HS DIST 90
Entity type:Organization
Organization Name:PONTIAC TWP HS DIST 90
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-844-6113
Mailing Address - Street 1:1100 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1204
Mailing Address - Country:US
Mailing Address - Phone:815-844-6113
Mailing Address - Fax:815-844-6116
Practice Address - Street 1:1100 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1204
Practice Address - Country:US
Practice Address - Phone:815-844-6113
Practice Address - Fax:815-844-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)