Provider Demographics
NPI:1497978464
Name:COMMUNITY CONS SCH DIST 204
Entity Type:Organization
Organization Name:COMMUNITY CONS SCH DIST 204
Other - Org Name:COMMUNITY CONSOLID SCH DIS 204
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-357-2419
Mailing Address - Street 1:6067 STATE ROUTE 154
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-3414
Mailing Address - Country:US
Mailing Address - Phone:618-357-2419
Mailing Address - Fax:618-357-3016
Practice Address - Street 1:6067 STATE ROUTE 154
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-3414
Practice Address - Country:US
Practice Address - Phone:618-357-2419
Practice Address - Fax:618-357-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-04-20
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=========001Medicaid