Provider Demographics
NPI:1972905438
Name:ARROWHEAD RANCH
Entity Type:Organization
Organization Name:ARROWHEAD RANCH
Other - Org Name:ARROWHEAD YOUTH & FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MPA
Authorized Official - Phone:309-799-7044
Mailing Address - Street 1:12200 104TH ST
Mailing Address - Street 2:PO BOX 370
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9712
Mailing Address - Country:US
Mailing Address - Phone:309-799-7044
Mailing Address - Fax:309-799-7574
Practice Address - Street 1:208 18TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8720
Practice Address - Country:US
Practice Address - Phone:309-781-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL460847251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management