Provider Demographics
NPI:1790953925
Name:CENTRAL COMMUNITY UNIT SCHOOL DIST #4
Entity Type:Organization
Organization Name:CENTRAL COMMUNITY UNIT SCHOOL DIST #4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-694-2231
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:IL
Mailing Address - Zip Code:60927-0637
Mailing Address - Country:US
Mailing Address - Phone:815-694-2231
Mailing Address - Fax:815-698-2575
Practice Address - Street 1:203 NORTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:ASHKUM
Practice Address - State:IL
Practice Address - Zip Code:60911
Practice Address - Country:US
Practice Address - Phone:815-694-2231
Practice Address - Fax:815-698-2575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363589360001OtherIL DEPT OF HEALTHCARE & F