Provider Demographics
NPI:1912042045
Name:MCLEAN COUNTY UNIT DISTRICT #5
Entity Type:Organization
Organization Name:MCLEAN COUNTY UNIT DISTRICT #5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTSEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-454-2220
Mailing Address - Street 1:412 E CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1777
Mailing Address - Country:US
Mailing Address - Phone:309-454-2220
Mailing Address - Fax:309-888-6013
Practice Address - Street 1:412 E CYPRESS ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1777
Practice Address - Country:US
Practice Address - Phone:309-454-2220
Practice Address - Fax:309-888-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376004011002Medicaid
IL3760040116176101Medicaid