Healthcare Provider Details

I. General information

NPI: 1710026745
Provider Name (Legal Business Name): WABASH OHIO VALLEY SPECIAL EDUCATION CFC 23
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S DIVISION ST
NORRIS CITY IL
62869-0320
US

IV. Provider business mailing address

PO BOX 320 800 S DIVISION ST
NORRIS CITY IL
62869-0320
US

V. Phone/Fax

Practice location:
  • Phone: 618-378-2131
  • Fax: 618-378-3127
Mailing address:
  • Phone: 618-378-2131
  • Fax: 618-378-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN J WILLIAMS
Title or Position: PROGRAM MANAGER
Credential:
Phone: 618-378-2131