Provider Demographics
NPI:1760604292
Name:MARISSA COMMUNITY UNIT SCHOOL DISTRICT 40
Entity Type:Organization
Organization Name:MARISSA COMMUNITY UNIT SCHOOL DISTRICT 40
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:REINHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-295-2313
Mailing Address - Street 1:300 SCHOOL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARISSA
Mailing Address - State:IL
Mailing Address - Zip Code:62257-2600
Mailing Address - Country:US
Mailing Address - Phone:618-295-2313
Mailing Address - Fax:618-295-2609
Practice Address - Street 1:300 SCHOOL VIEW DR
Practice Address - Street 2:
Practice Address - City:MARISSA
Practice Address - State:IL
Practice Address - Zip Code:62257-2600
Practice Address - Country:US
Practice Address - Phone:618-295-2313
Practice Address - Fax:618-295-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
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