Provider Demographics
NPI:1174631907
Name:OAKWOOD COMMUNITY UNIT SCHOOL DISTRICT #76
Entity Type:Organization
Organization Name:OAKWOOD COMMUNITY UNIT SCHOOL DISTRICT #76
Other - Org Name:COMMUNITY UNIT SCHOOL DIST 76
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-354-4355
Mailing Address - Street 1:5834 SOUTH ROUTE 150
Mailing Address - Street 2:
Mailing Address - City:FITHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:61844
Mailing Address - Country:US
Mailing Address - Phone:217-354-4355
Mailing Address - Fax:
Practice Address - Street 1:5834 SOUTH ROUTE 150
Practice Address - Street 2:
Practice Address - City:FITHIAN
Practice Address - State:IL
Practice Address - Zip Code:61844
Practice Address - Country:US
Practice Address - Phone:217-354-4355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid