Provider Demographics
NPI:1467402206
Name:FORD COUNTY SPECIAL EDUCATION COOPERATIVE
Entity Type:Organization
Organization Name:FORD COUNTY SPECIAL EDUCATION COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-784-5470
Mailing Address - Street 1:217 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1072
Mailing Address - Country:US
Mailing Address - Phone:217-784-5470
Mailing Address - Fax:217-784-8293
Practice Address - Street 1:217 E 17TH ST
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1072
Practice Address - Country:US
Practice Address - Phone:217-784-5470
Practice Address - Fax:217-784-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
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