Provider Demographics
NPI:1811012883
Name:CARLINVILLE COMMUNITY UNIT SCHOOL DISTRICT #1
Entity Type:Organization
Organization Name:CARLINVILLE COMMUNITY UNIT SCHOOL DISTRICT #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-854-9823
Mailing Address - Street 1:18456 SHIPMAN RD
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-9238
Mailing Address - Country:US
Mailing Address - Phone:217-854-9823
Mailing Address - Fax:217-854-2777
Practice Address - Street 1:18456 SHIPMAN RD
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-9238
Practice Address - Country:US
Practice Address - Phone:217-854-9823
Practice Address - Fax:217-854-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
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