Provider Demographics
NPI:1164560850
Name:NOKOMIS CUSD 22
Entity Type:Organization
Organization Name:NOKOMIS CUSD 22
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHROSTOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-563-7311
Mailing Address - Street 1:511 OBERLE ST
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:IL
Mailing Address - Zip Code:62075-1015
Mailing Address - Country:US
Mailing Address - Phone:217-563-7311
Mailing Address - Fax:217-563-2549
Practice Address - Street 1:511 OBERLE ST
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:IL
Practice Address - Zip Code:62075-1015
Practice Address - Country:US
Practice Address - Phone:217-563-7311
Practice Address - Fax:217-563-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid