Provider Demographics
NPI:1346442852
Name:SPOON RIVER VALLEY CUS DIST 4
Entity Type:Organization
Organization Name:SPOON RIVER VALLEY CUS DIST 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-837-3911
Mailing Address - Street 1:35265 N IL 97
Mailing Address - Street 2:
Mailing Address - City:LONDON MILLS
Mailing Address - State:IL
Mailing Address - Zip Code:61544-9801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35265 N IL 97
Practice Address - Street 2:
Practice Address - City:LONDON MILLS
Practice Address - State:IL
Practice Address - Zip Code:61544-9801
Practice Address - Country:US
Practice Address - Phone:309-837-3911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)