Provider Demographics
NPI:1982821062
Name:LICK CREEK C.C. SCHOOL DISTRICT #16
Entity Type:Organization
Organization Name:LICK CREEK C.C. SCHOOL DISTRICT #16
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-833-2545
Mailing Address - Street 1:7355 LICK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BUNCOMBE
Mailing Address - State:IL
Mailing Address - Zip Code:62912-3016
Mailing Address - Country:US
Mailing Address - Phone:618-833-2545
Mailing Address - Fax:618-833-3201
Practice Address - Street 1:7355 LICK CREEK RD
Practice Address - Street 2:
Practice Address - City:BUNCOMBE
Practice Address - State:IL
Practice Address - Zip Code:62912-3016
Practice Address - Country:US
Practice Address - Phone:618-833-2545
Practice Address - Fax:618-833-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1000X
IL261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid