Provider Demographics
NPI:1275869695
Name:THE ROCK CHURCH OF DANVILLE INC.
Entity Type:Organization
Organization Name:THE ROCK CHURCH OF DANVILLE INC.
Other - Org Name:ORTIZ COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR PASTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-443-6219
Mailing Address - Street 1:20 POLAND RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-7463
Mailing Address - Country:US
Mailing Address - Phone:217-443-6219
Mailing Address - Fax:
Practice Address - Street 1:1101 E WINTER AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-2295
Practice Address - Country:US
Practice Address - Phone:217-443-1966
Practice Address - Fax:217-446-1930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ROCK CHURCH OF DANVILLE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18006719101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty