Provider Demographics
NPI:1902078264
Name:ST ROSE ELEM DIST 14 AND 15
Entity Type:Organization
Organization Name:ST ROSE ELEM DIST 14 AND 15
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-532-4721
Mailing Address - Street 1:18004 SAINT ROSE RD
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-2578
Mailing Address - Country:US
Mailing Address - Phone:618-526-7484
Mailing Address - Fax:618-526-7168
Practice Address - Street 1:18004 SAINT ROSE RD
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-2578
Practice Address - Country:US
Practice Address - Phone:618-526-7484
Practice Address - Fax:618-526-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)