Healthcare Provider Details

I. General information

NPI: 1811162423
Provider Name (Legal Business Name): GRAYVILLE CUSD #1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 W NORTH ST
GRAYVILLE IL
62844-1338
US

IV. Provider business mailing address

704 W NORTH ST
GRAYVILLE IL
62844-1338
US

V. Phone/Fax

Practice location:
  • Phone: 618-375-7214
  • Fax:
Mailing address:
  • Phone:
  • 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: MARLENE J WILLIAMS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 618-375-7214