Provider Demographics
NPI:1003946039
Name:ROME CCSD #2
Entity Type:Organization
Organization Name:ROME CCSD #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-266-7214
Mailing Address - Street 1:233 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:DIX
Mailing Address - State:IL
Mailing Address - Zip Code:62830-1403
Mailing Address - Country:US
Mailing Address - Phone:618-266-7214
Mailing Address - Fax:618-266-7902
Practice Address - Street 1:233 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:DIX
Practice Address - State:IL
Practice Address - Zip Code:62830-1403
Practice Address - Country:US
Practice Address - Phone:618-266-7214
Practice Address - Fax:618-266-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid