Provider Demographics
NPI:1912175985
Name:PEARL CITY COMM UNIT DIST 200
Entity type:Organization
Organization Name:PEARL CITY COMM UNIT DIST 200
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-443-2715
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:61062-0009
Mailing Address - Country:US
Mailing Address - Phone:815-433-2715
Mailing Address - Fax:
Practice Address - Street 1:2037 W GALENA AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-3004
Practice Address - Country:US
Practice Address - Phone:815-433-2715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
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