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General NPI Number Information
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NPI Number | 1326217100
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH CCSD #169
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 404 S 5TH ST
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City | SAINT JOSEPH
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State | IL
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Zip | 61873-9073
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Country | US
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Telephone | 217-469-2291
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Fax | 217-469-8906
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Provider Business Mailing Address
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Address Line | 404 S 5TH ST
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City | SAINT JOSEPH
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State | IL
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Zip | 61873-9073
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Country | US
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Telephone | 217-469-2291
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Fax | 217-469-8906
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | MR. TODD EUGENE PENCE
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Credential |
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Telephone | 217-469-2291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 001
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License Number State | IL
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