Provider Demographics
NPI:1669641205
Name:ASSOCIATION FOR RETARDED CITIZENS OF ROCK ISLAND COUNTY
Entity Type:Organization
Organization Name:ASSOCIATION FOR RETARDED CITIZENS OF ROCK ISLAND COUNTY
Other - Org Name:NINTH STREET PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FISCAL OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAUGHTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-786-6474
Mailing Address - Street 1:2850 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5210
Mailing Address - Country:US
Mailing Address - Phone:309-786-6474
Mailing Address - Fax:309-786-9861
Practice Address - Street 1:2850 9TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5210
Practice Address - Country:US
Practice Address - Phone:309-786-6474
Practice Address - Fax:309-786-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0038505315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities