Provider Demographics
NPI:1235350273
Name:BLUE RIDGE CUSD #18
Entity Type:Organization
Organization Name:BLUE RIDGE CUSD #18
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-928-9141
Mailing Address - Street 1:411 N JOHN ST
Mailing Address - Street 2:
Mailing Address - City:FARMER CITY
Mailing Address - State:IL
Mailing Address - Zip Code:61842
Mailing Address - Country:US
Mailing Address - Phone:309-928-9141
Mailing Address - Fax:309-928-5478
Practice Address - Street 1:411 N JOHN ST
Practice Address - Street 2:
Practice Address - City:FARMER CITY
Practice Address - State:IL
Practice Address - Zip Code:61842-1159
Practice Address - Country:US
Practice Address - Phone:309-928-9141
Practice Address - Fax:309-928-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid