Provider Demographics
NPI:1558456111
Name:TRI VALLEY COMMUNITY UNIT SCHOOL DISTRICT #3
Entity Type:Organization
Organization Name:TRI VALLEY COMMUNITY UNIT SCHOOL DISTRICT #3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-378-2351
Mailing Address - Street 1:410 EAST WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:DOWNS
Mailing Address - State:IL
Mailing Address - Zip Code:61736
Mailing Address - Country:US
Mailing Address - Phone:309-378-2351
Mailing Address - Fax:309-378-2223
Practice Address - Street 1:410 EAST WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:DOWNS
Practice Address - State:IL
Practice Address - Zip Code:61736
Practice Address - Country:US
Practice Address - Phone:309-378-2351
Practice Address - Fax:309-378-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
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