Provider Demographics
NPI:1467674804
Name:MOUNT PULASKI COMMUNITY UNIT DISTRICT NO 23
Entity Type:Organization
Organization Name:MOUNT PULASKI COMMUNITY UNIT DISTRICT NO 23
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-792-7231
Mailing Address - Street 1:119 N GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PULASKI
Mailing Address - State:IL
Mailing Address - Zip Code:62548-1285
Mailing Address - Country:US
Mailing Address - Phone:217-792-7222
Mailing Address - Fax:217-792-5551
Practice Address - Street 1:119 N GARDEN ST
Practice Address - Street 2:
Practice Address - City:MOUNT PULASKI
Practice Address - State:IL
Practice Address - Zip Code:62548-1285
Practice Address - Country:US
Practice Address - Phone:217-792-7222
Practice Address - Fax:217-792-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid