Provider Demographics
NPI: | 1164523775 |
---|---|
Name: | BALL CHATHAM COMM UNIT SCHOOL DISTRICT 5 |
Entity Type: | Organization |
Organization Name: | BALL CHATHAM COMM UNIT SCHOOL DISTRICT 5 |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SUPERINTENDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VOLTZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 217-483-2416 |
Mailing Address - Street 1: | 201 MULBERRY STREET |
Mailing Address - Street 2: | |
Mailing Address - City: | CHATHAM |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 62629 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 217-483-2416 |
Mailing Address - Fax: | 217-483-2940 |
Practice Address - Street 1: | 201 MULBERRY STREET |
Practice Address - Street 2: | |
Practice Address - City: | CHATHAM |
Practice Address - State: | IL |
Practice Address - Zip Code: | 62629 |
Practice Address - Country: | US |
Practice Address - Phone: | 217-483-2416 |
Practice Address - Fax: | 217-483-2940 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-26 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251300000X | Agencies | Local Education Agency (LEA) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | =========001 | Medicaid |