Provider Demographics
NPI:1578671368
Name:WILLIAMSVILLE COMM UNIT SCHOOL DIST 15
Entity type:Organization
Organization Name:WILLIAMSVILLE COMM UNIT SCHOOL DIST 15
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-566-2014
Mailing Address - Street 1:800 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62693-9729
Mailing Address - Country:US
Mailing Address - Phone:217-566-2014
Mailing Address - Fax:217-566-3890
Practice Address - Street 1:800 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62693-9729
Practice Address - Country:US
Practice Address - Phone:217-566-2014
Practice Address - Fax:217-566-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
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=========001Medicaid