Provider Demographics
NPI:1750428116
Name:MASCOUTAH COMMUNITY SCHOOL DISTRICT #19
Entity type:Organization
Organization Name:MASCOUTAH COMMUNITY SCHOOL DISTRICT #19
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-566-8223
Mailing Address - Street 1:720 W HARNETT ST
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-1121
Mailing Address - Country:US
Mailing Address - Phone:618-566-8223
Mailing Address - Fax:618-566-4507
Practice Address - Street 1:720 W HARNETT ST
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-1121
Practice Address - Country:US
Practice Address - Phone:618-566-8223
Practice Address - Fax:618-566-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
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