Provider Demographics
NPI:1285856708
Name:LEBANON COMMUNITY UNIT SCHOOL DISTRICT 9
Entity type:Organization
Organization Name:LEBANON COMMUNITY UNIT SCHOOL DISTRICT 9
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-537-4611
Mailing Address - Street 1:200 W SCHUETZ ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IL
Mailing Address - Zip Code:62254-1570
Mailing Address - Country:US
Mailing Address - Phone:618-537-4611
Mailing Address - Fax:618-537-9588
Practice Address - Street 1:200 W SCHUETZ ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IL
Practice Address - Zip Code:62254-1570
Practice Address - Country:US
Practice Address - Phone:618-537-4611
Practice Address - Fax:618-537-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid