Provider Demographics
NPI:1306117304
Name:FOX LAKE GRADE SCHOOL DISTRICT #114
Entity type:Organization
Organization Name:FOX LAKE GRADE SCHOOL DISTRICT #114
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-973-4028
Mailing Address - Street 1:29067 W GRASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-9494
Mailing Address - Country:US
Mailing Address - Phone:847-973-4028
Mailing Address - Fax:847-973-4010
Practice Address - Street 1:29067 W GRASS LAKE RD
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-9494
Practice Address - Country:US
Practice Address - Phone:847-973-4028
Practice Address - Fax:847-973-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health