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NPI #1700416500 in Rock Island, Illinois

Provider Information

NPI Number
1700416500
Entity Type
Organization
Organization Name
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Subpart
Yes (part of a larger organization)
Parent Organization
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Primary Specialty
Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date
Jan 21, 2020
Last Updated
Jan 21, 2020

Practice Location

Address
2202 18TH AVE
ZIP Code
61201-3614
Phone
(309) 793-4993

Authorized Official

Name
KRISTY LEE RODGERS
Title
CFO
Phone
(309) 283-1224

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Mental Health (Including Community Mental Health Center)Mental Health (Including Community Mental Health Center)

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