Provider Demographics
NPI:1902077043
Name:UNITY POINT SCHOOL
Entity Type:Organization
Organization Name:UNITY POINT SCHOOL
Other - Org Name:UNITY POINT CC SCHOOL DIST 140
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:LASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-529-4151
Mailing Address - Street 1:4033 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-8375
Mailing Address - Country:US
Mailing Address - Phone:618-529-4151
Mailing Address - Fax:618-529-4154
Practice Address - Street 1:4033 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-8375
Practice Address - Country:US
Practice Address - Phone:618-529-4151
Practice Address - Fax:618-529-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6290101Medicaid