| Organization Name: | ST. JOSEPH CCSD #169 |
| NPI Number: | 1326217100 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TODD EUGENE PENCE (SUPERINTENDENT) |
| Mailing Address: | 404 S 5th St Saint Joseph |
| State: | IL US |
| Postal Code: | 618739073 |
| Phone Number: | 2174692291 |
| Fax Number: | 2174698906 |
| NPI Enumeration Date: | 02/26/2008 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | =========001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |