Provider Demographics
NPI:1508982703
Name:GIANT CITY CC SCHOOL DIST 130
Entity Type:Organization
Organization Name:GIANT CITY CC SCHOOL DIST 130
Other - Org Name:GIANT CITY SCHOOL DISTRICT 130
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS EDUCATION ADMIN
Authorized Official - Phone:618-457-5391
Mailing Address - Street 1:1062 BOSKYDELL RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-7743
Mailing Address - Country:US
Mailing Address - Phone:618-457-5391
Mailing Address - Fax:618-549-5060
Practice Address - Street 1:1062 BOSKYDELL RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62902-7743
Practice Address - Country:US
Practice Address - Phone:618-457-5391
Practice Address - Fax:618-549-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
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=========002Medicaid