Healthcare Provider Details

I. General information

NPI: 1679757397
Provider Name (Legal Business Name): CENTRAL A AND M COMMUNITY UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N COLLEGE ST
ASSUMPTION IL
62510-1032
US

IV. Provider business mailing address

105 N COLLEGE ST
ASSUMPTION IL
62510-1032
US

V. Phone/Fax

Practice location:
  • Phone: 217-226-4042
  • Fax:
Mailing address:
  • Phone: 217-226-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: RANDY GRIGG
Title or Position: SUPERINTENDENT
Credential:
Phone: 217-226-4042