Provider Demographics
NPI:1477728277
Name:TRICO SCHOOL DIST 176
Entity Type:Organization
Organization Name:TRICO SCHOOL DIST 176
Other - Org Name:TRICO UNIT SCH DIST 176
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-426-1111
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62916-0220
Mailing Address - Country:US
Mailing Address - Phone:618-426-1111
Mailing Address - Fax:618-426-3625
Practice Address - Street 1:16411 HIGHWAY 4
Practice Address - Street 2:
Practice Address - City:CAMPBELL HILL
Practice Address - State:IL
Practice Address - Zip Code:62916-0220
Practice Address - Country:US
Practice Address - Phone:618-426-1111
Practice Address - Fax:618-426-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6291603Medicaid