Provider Demographics
NPI:1326189374
Name:EDWARDS COUNTY CUSD 1
Entity Type:Organization
Organization Name:EDWARDS COUNTY CUSD 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:618-445-2814
Mailing Address - Street 1:37 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IL
Mailing Address - Zip Code:62806-1006
Mailing Address - Country:US
Mailing Address - Phone:618-445-2814
Mailing Address - Fax:618-445-2272
Practice Address - Street 1:37 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-1006
Practice Address - Country:US
Practice Address - Phone:618-445-2814
Practice Address - Fax:618-445-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
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=========004Medicaid