Provider Demographics
NPI:1275620544
Name:CRESCENT CITY COMMUNITY UNIT SCHOOL DISTRICT #275
Entity Type:Organization
Organization Name:CRESCENT CITY COMMUNITY UNIT SCHOOL DISTRICT #275
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRT
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-683-2141
Mailing Address - Street 1:600 SOUTH STREET
Mailing Address - Street 2:PO BOX 190
Mailing Address - City:CRESCENT CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60928
Mailing Address - Country:US
Mailing Address - Phone:815-683-2141
Mailing Address - Fax:815-683-2219
Practice Address - Street 1:600 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:IL
Practice Address - Zip Code:60928
Practice Address - Country:US
Practice Address - Phone:815-683-2141
Practice Address - Fax:815-683-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid