Provider Demographics
NPI:1609972165
Name:CHARLESTON COMMUNITY UNIT SCHOOL DISTRICT #1
Entity Type:Organization
Organization Name:CHARLESTON COMMUNITY UNIT SCHOOL DISTRICT #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-639-1000
Mailing Address - Street 1:410 W POLK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2557
Mailing Address - Country:US
Mailing Address - Phone:217-639-1000
Mailing Address - Fax:217-639-1005
Practice Address - Street 1:410 W POLK AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2557
Practice Address - Country:US
Practice Address - Phone:217-639-1000
Practice Address - Fax:217-639-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
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