Provider Demographics
NPI:1730225384
Name:CARMI-WHITE CO. C.U.S.D. NO. 5
Entity type:Organization
Organization Name:CARMI-WHITE CO. C.U.S.D. NO. 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:618-382-2341
Mailing Address - Street 1:301 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1474
Mailing Address - Country:US
Mailing Address - Phone:618-382-2341
Mailing Address - Fax:618-384-3207
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1474
Practice Address - Country:US
Practice Address - Phone:618-382-2341
Practice Address - Fax:618-384-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid