Healthcare Provider Details

I. General information

NPI: 1871764886
Provider Name (Legal Business Name): GRAYVILLE COMMUNITY UNIT SCHOOL DISTRICT #1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 W NORTH ST
GRAYVILLE IL
62844-1338
US

IV. Provider business mailing address

728 W NORTH ST
GRAYVILLE IL
62844-1338
US

V. Phone/Fax

Practice location:
  • Phone: 618-375-7114
  • Fax:
Mailing address:
  • Phone: 618-375-7114
  • 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: DAVID SCOTT
Title or Position: SUPERINTENDENT
Credential:
Phone: 618-375-7114