Provider Demographics
NPI:1659754455
Name:SOUTH FORK SCHOOL DIST #14
Entity Type:Organization
Organization Name:SOUTH FORK SCHOOL DIST #14
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DULAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-237-4331
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:KINCAID
Mailing Address - State:IL
Mailing Address - Zip Code:62540-0020
Mailing Address - Country:US
Mailing Address - Phone:217-237-4331
Mailing Address - Fax:217-237-2245
Practice Address - Street 1:550 PRAIRIE STREET
Practice Address - Street 2:
Practice Address - City:KINCAID
Practice Address - State:IL
Practice Address - Zip Code:62540-0020
Practice Address - Country:US
Practice Address - Phone:217-237-4331
Practice Address - Fax:217-237-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1001101014024Medicaid