Provider Demographics
NPI:1386741403
Name:CUMBERLAND COMMUNITY UNIT SCHOOL DISTRICT 77
Entity type:Organization
Organization Name:CUMBERLAND COMMUNITY UNIT SCHOOL DISTRICT 77
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-923-3132
Mailing Address - Street 1:1496 ILLINOIS ROUTE 121
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IL
Mailing Address - Zip Code:62468-4214
Mailing Address - Country:US
Mailing Address - Phone:217-923-3132
Mailing Address - Fax:217-923-3132
Practice Address - Street 1:1496 ILLINOIS ROUTE 121
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IL
Practice Address - Zip Code:62468-4214
Practice Address - Country:US
Practice Address - Phone:217-923-3132
Practice Address - Fax:217-923-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
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