Provider Demographics
NPI:1124247507
Name:CLINTON UNIT SCHOOL DISTRICT 15
Entity type:Organization
Organization Name:CLINTON UNIT SCHOOL DISTRICT 15
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:IMIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-935-8321
Mailing Address - Street 1:1210 STATE ROUTE 54 WEST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727
Mailing Address - Country:US
Mailing Address - Phone:217-935-8321
Mailing Address - Fax:217-935-2300
Practice Address - Street 1:1210 STATE ROUTE 54 WEST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727
Practice Address - Country:US
Practice Address - Phone:217-935-8321
Practice Address - Fax:217-935-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
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