Provider Demographics
NPI:1689813529
Name:QUAD CITIES AUTISM CENTER INC.
Entity Type:Organization
Organization Name:QUAD CITIES AUTISM CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMYTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-269-5653
Mailing Address - Street 1:2430 6TH AVE
Mailing Address - Street 2:102
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-1539
Mailing Address - Country:US
Mailing Address - Phone:309-269-5653
Mailing Address - Fax:
Practice Address - Street 1:2430 6TH AVE
Practice Address - Street 2:102
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1539
Practice Address - Country:US
Practice Address - Phone:309-269-5653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health