Provider Demographics
NPI:1396846903
Name:RIVERTON COMM UNIT SCHOOL DISTRICT 14
Entity type:Organization
Organization Name:RIVERTON COMM UNIT SCHOOL DISTRICT 14
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-629-6009
Mailing Address - Street 1:6425 OLD ROUTE 36
Mailing Address - Street 2:PO BOX 1010
Mailing Address - City:RIVERTON
Mailing Address - State:IL
Mailing Address - Zip Code:62561
Mailing Address - Country:US
Mailing Address - Phone:217-629-6009
Mailing Address - Fax:217-629-6008
Practice Address - Street 1:6425 OLD ROUTE 36
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:IL
Practice Address - Zip Code:62561
Practice Address - Country:US
Practice Address - Phone:217-629-6009
Practice Address - Fax:217-629-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
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