Provider Demographics
NPI:1518073634
Name:ROCK ISLAND SUPPORTIVE LIVING CENTER
Entity Type:Organization
Organization Name:ROCK ISLAND SUPPORTIVE LIVING CENTER
Other - Org Name:THE FORT ARMSTRONG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:HALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-452-6804
Mailing Address - Street 1:1900 3RD AVE.
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201
Mailing Address - Country:US
Mailing Address - Phone:309-786-0400
Mailing Address - Fax:309-786-9729
Practice Address - Street 1:1900 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-786-0400
Practice Address - Fax:309-786-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility