Provider Demographics
NPI:1396113312
Name:SALT FORK COMMUNITY UNIT SCHOOL DISTRICT 512
Entity type:Organization
Organization Name:SALT FORK COMMUNITY UNIT SCHOOL DISTRICT 512
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:217-288-9306
Mailing Address - Street 1:7087 N 600 EAST RD
Mailing Address - Street 2:
Mailing Address - City:SIDELL
Mailing Address - State:IL
Mailing Address - Zip Code:61876-6515
Mailing Address - Country:US
Mailing Address - Phone:217-288-9306
Mailing Address - Fax:217-288-9393
Practice Address - Street 1:7087 N 600 EAST RD
Practice Address - Street 2:
Practice Address - City:SIDELL
Practice Address - State:IL
Practice Address - Zip Code:61876-6515
Practice Address - Country:US
Practice Address - Phone:217-288-9306
Practice Address - Fax:217-288-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)