Provider Demographics
NPI:1134397649
Name:CENTRAL CUSD 301
Entity type:Organization
Organization Name:CENTRAL CUSD 301
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:RABENHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-464-6005
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:275 SOUTH ST
Mailing Address - City:BURLINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60109
Mailing Address - Country:US
Mailing Address - Phone:847-464-6005
Mailing Address - Fax:847-464-6021
Practice Address - Street 1:275 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IL
Practice Address - Zip Code:60109
Practice Address - Country:US
Practice Address - Phone:847-464-6005
Practice Address - Fax:847-464-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid