Provider Demographics
NPI:1356561666
Name:BELLEVILLE AREA SPC SRV CO - ADM
Entity type:Organization
Organization Name:BELLEVILLE AREA SPC SRV CO - ADM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-355-4700
Mailing Address - Street 1:2411 PATHWAYS CROSSING
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221
Mailing Address - Country:US
Mailing Address - Phone:618-355-4700
Mailing Address - Fax:618-355-4758
Practice Address - Street 1:2411 PATHWAYS CROSSING
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221
Practice Address - Country:US
Practice Address - Phone:618-355-4700
Practice Address - Fax:618-355-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
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
IL376004522001Medicaid