Provider Demographics
NPI:1245236942
Name:CENTER FOR ALCHOL & DRUG SERVICES, INC.
Entity Type:Organization
Organization Name:CENTER FOR ALCHOL & DRUG SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:COWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-326-4116
Mailing Address - Street 1:1523 S FAIRMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52802-3644
Mailing Address - Country:US
Mailing Address - Phone:563-322-2667
Mailing Address - Fax:563-322-3671
Practice Address - Street 1:1523 S FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802
Practice Address - Country:US
Practice Address - Phone:563-322-2667
Practice Address - Fax:563-322-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0438-0002-A261QM2800X, 261QR0405X
IA324500000X
IL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder