Provider Demographics
NPI:1861736563
Name:LAGRANGE SCHOOL DISTRICT 105
Entity type:Organization
Organization Name:LAGRANGE SCHOOL DISTRICT 105
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLICHTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-482-2700
Mailing Address - Street 1:701 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6705
Mailing Address - Country:US
Mailing Address - Phone:708-482-2700
Mailing Address - Fax:708-482-2727
Practice Address - Street 1:701 7TH AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6705
Practice Address - Country:US
Practice Address - Phone:708-482-2700
Practice Address - Fax:708-482-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3660063476052502Medicaid