Provider Demographics
NPI:1770614877
Name:DIAMOND LAKE SCH DIST 76
Entity type:Organization
Organization Name:DIAMOND LAKE SCH DIST 76
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-566-9221
Mailing Address - Street 1:25807 N DIAMOND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-9415
Mailing Address - Country:US
Mailing Address - Phone:847-566-9221
Mailing Address - Fax:847-566-5689
Practice Address - Street 1:25807 N DIAMOND LAKE RD
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-9415
Practice Address - Country:US
Practice Address - Phone:847-566-9221
Practice Address - Fax:847-566-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)