Provider Demographics
NPI:1396930988
Name:ILLINOIS SCHOOLD FOR THE DEAF
Entity type:Organization
Organization Name:ILLINOIS SCHOOLD FOR THE DEAF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUDERDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-479-4201
Mailing Address - Street 1:400 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-2625
Mailing Address - Country:US
Mailing Address - Phone:217-524-4089
Mailing Address - Fax:217-524-2352
Practice Address - Street 1:125 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1877
Practice Address - Country:US
Practice Address - Phone:217-479-4200
Practice Address - Fax:217-479-4209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILLINOIS DEPARTMENT OF HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376002057002Medicaid