Provider Demographics
NPI:1376909309
Name:THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH
Entity Type:Organization
Organization Name:THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH
Other - Org Name:ROBERT YOUNG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-779-2043
Mailing Address - Street 1:4600 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6106
Mailing Address - Country:US
Mailing Address - Phone:309-779-2031
Mailing Address - Fax:309-779-5222
Practice Address - Street 1:4600 3RD ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6106
Practice Address - Country:US
Practice Address - Phone:309-779-2031
Practice Address - Fax:309-779-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5M00000032251S00000X
261QM0801X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL144649OtherMEDICARE PTAN