Healthcare Provider Details

I. General information

NPI: 1578671368
Provider Name (Legal Business Name): WILLIAMSVILLE COMM UNIT SCHOOL DIST 15
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S WALNUT ST
WILLIAMSVILLE IL
62693-9729
US

IV. Provider business mailing address

800 S WALNUT ST
WILLIAMSVILLE IL
62693-9729
US

V. Phone/Fax

Practice location:
  • Phone: 217-566-2014
  • Fax: 217-566-3890
Mailing address:
  • Phone: 217-566-2014
  • Fax: 217-566-3890

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: RANDOLPH HARHAUSEN
Title or Position: SUPERINTENDENT
Credential:
Phone: 217-566-2014