Provider Demographics
NPI:1679758387
Name:COMMUNITY COLLEGE DISTRICT 536
Entity type:Organization
Organization Name:COMMUNITY COLLEGE DISTRICT 536
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-468-4440
Mailing Address - Street 1:5800 GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2426
Mailing Address - Country:US
Mailing Address - Phone:618-468-4440
Mailing Address - Fax:
Practice Address - Street 1:5800 GODFREY RD
Practice Address - Street 2:FOBES 1525
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2426
Practice Address - Country:US
Practice Address - Phone:618-468-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty