Provider Demographics
NPI:1124575733
Name:ROBERT YOUNG CENTER
Entity Type:Organization
Organization Name:ROBERT YOUNG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-779-3060
Mailing Address - Street 1:2701-17 STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201
Mailing Address - Country:US
Mailing Address - Phone:309-779-2957
Mailing Address - Fax:
Practice Address - Street 1:2701 - 17 STREET
Practice Address - Street 2:
Practice Address - City:ROCKISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-799-2957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITY POINT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness