Provider Demographics
NPI:1689852733
Name:THE ARC OF WINNEBAGO, BOONE AND OGLE COUNTIES
Entity Type:Organization
Organization Name:THE ARC OF WINNEBAGO, BOONE AND OGLE COUNTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIL BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-965-3455
Mailing Address - Street 1:1222 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2230
Mailing Address - Country:US
Mailing Address - Phone:815-965-3455
Mailing Address - Fax:815-965-3673
Practice Address - Street 1:1222 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2230
Practice Address - Country:US
Practice Address - Phone:815-965-3455
Practice Address - Fax:815-965-3673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable