Provider Demographics
NPI:1598897993
Name:RURAL CHAMPAIGN CO SPC ED COOP
Entity Type:Organization
Organization Name:RURAL CHAMPAIGN CO SPC ED COOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-892-8877
Mailing Address - Street 1:807 N MATTIS
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-2448
Mailing Address - Country:US
Mailing Address - Phone:217-892-8877
Mailing Address - Fax:217-893-8627
Practice Address - Street 1:807 N MATTIS
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-2448
Practice Address - Country:US
Practice Address - Phone:217-892-8877
Practice Address - Fax:217-893-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
IL261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health