Healthcare Provider Details

I. General information

NPI: 1568579258
Provider Name (Legal Business Name): COMMUNITY UNIT SCHOOL DIST 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17268 EAST 2750 NORTH RD
BISMARCK IL
61814
US

IV. Provider business mailing address

17268 EAST 2750 NORTH RD
BISMARCK IL
61814
US

V. Phone/Fax

Practice location:
  • Phone: 217-759-7261
  • Fax:
Mailing address:
  • Phone: 217-759-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: RANDY HIRD
Title or Position: SUPERINTENDENT
Credential:
Phone: 217-759-7261