MEDICARE: CUMBERLAND COMMUNITY UNIT SCHOOL DISTRICT 77

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1386741403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMBERLAND COMMUNITY UNIT SCHOOL DISTRICT 77

Provider Business Mailing Address
First Line	:	1496 ILLINOIS ROUTE 121
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-4214
Country	:	US
Telephone Number	:	217-923-3132
Fax Number	:	217-923-3132

Provider Business Practice Location Address
First Line	:	1496 ILLINOIS ROUTE 121
Second Line	:
City	:	TOLEDO
State	:	IL
Zip	:	62468-4214
Country	:	US
Telephone Number	:	217-923-3132
Fax Number	:	217-923-3132

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	RUSSELL RAGON
Credential	:
Telephone Number	:	217-923-3132

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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