Provider Demographics
NPI:1417049701
Name:DONOVAN COMM UNIT SCHOOL DISTRICT 3
Entity Type:Organization
Organization Name:DONOVAN COMM UNIT SCHOOL DISTRICT 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-486-7398
Mailing Address - Street 1:600 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:DONOVAN
Mailing Address - State:IL
Mailing Address - Zip Code:60931
Mailing Address - Country:US
Mailing Address - Phone:815-486-7398
Mailing Address - Fax:815-486-7060
Practice Address - Street 1:600 NORTH STREET
Practice Address - Street 2:
Practice Address - City:DONOVAN
Practice Address - State:IL
Practice Address - Zip Code:60931
Practice Address - Country:US
Practice Address - Phone:815-486-7398
Practice Address - Fax:815-486-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
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