Provider Demographics
NPI:1629289590
Name:QUACKENBUSH, INC
Entity Type:Organization
Organization Name:QUACKENBUSH, INC
Other - Org Name:ARC COUNSELING CENTER, GREELEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACKENBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-302-5997
Mailing Address - Street 1:1024 9TH AVENUE, SUITE 10
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631
Mailing Address - Country:US
Mailing Address - Phone:970-302-5997
Mailing Address - Fax:
Practice Address - Street 1:1024 9TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4037
Practice Address - Country:US
Practice Address - Phone:970-302-5997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health