Provider Demographics
NPI:1154597698
Name:DONGOLA SCHOOL UNIT DIST 66
Entity type:Organization
Organization Name:DONGOLA SCHOOL UNIT DIST 66
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-827-3841
Mailing Address - Street 1:1000 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:DONGOLA
Mailing Address - State:IL
Mailing Address - Zip Code:62926
Mailing Address - Country:US
Mailing Address - Phone:618-827-3841
Mailing Address - Fax:618-827-4641
Practice Address - Street 1:1000 HIGH STREET
Practice Address - Street 2:
Practice Address - City:DONGOLA
Practice Address - State:IL
Practice Address - Zip Code:62926
Practice Address - Country:US
Practice Address - Phone:618-827-3841
Practice Address - Fax:618-827-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X, 261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid