Organization
TRI COUNTY SP ED JNT AGREEMENT
Active
Other names
Elverado CU School Dist 196
Organization subpart
No
Provider details
NPI number
Authorized official
MS. H. REBECCA CANTY (SUPERINTENDENT)
(618) 568-1321
Entity
Organization
Contact information
Practice address
114 S. 8TH STREET, ELKVILLE, IL 62932-0130
(618) 568-1321
(618) 568-1152
Mailing address
114 S. 8TH STREET, P.O. BOX 130, ELKVILLE, IL 62924-0130
(618) 568-1321
(618) 568-1152
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376022272001
—
IL
Enumeration date
03/26/2007
Last updated
08/22/2020
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