Provider Demographics
NPI:1073979092
Name:MACON PIATT COUNTY SPEC ED DIST
Entity Type:Organization
Organization Name:MACON PIATT COUNTY SPEC ED DIST
Other - Org Name:MACON PIATT SPECIAL EDUCATION DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-424-3131
Mailing Address - Street 1:335 E CERRO GORDO ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1013
Mailing Address - Country:US
Mailing Address - Phone:217-424-3030
Mailing Address - Fax:
Practice Address - Street 1:335 E CERRO GORDO ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1013
Practice Address - Country:US
Practice Address - Phone:217-424-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR SCHOOL DIST 61
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL39055061061251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002OtherILLINOIS HEALTHCARE & FAMILY SERVICES MEDICAID PROVIDER NUMBER