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Organization
KANKAKEE SCHOOL DISTRICT 111 SCHOOL-BASED HEALTH CENTER
Active
Organization
KANKAKEE SCHOOL DISTRICT 111 SCHOOL-BASED HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN ALI (SUPERINTENDENT)
(815) 933-0772
Entity
Organization
Contact information
Practice address
2250 E CRESTWOOD ST, KANKAKEE, IL 60901-2803
(815) 933-0772
(815) 933-6730
Mailing address
2250 E CRESTWOOD ST, KANKAKEE, IL 60901-2803
(815) 933-0772
(815) 933-6730
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
IL
261QS1000X
Student Health Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
336004784004
—
IL
Enumeration date
03/23/2007
Last updated
04/20/2008
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