Provider Demographics
NPI:1831716745
Name:THE PROJECT OF THE QUAD CITIES
Entity type:Organization
Organization Name:THE PROJECT OF THE QUAD CITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-964-4036
Mailing Address - Street 1:1620 W. NORTHWEST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-572-0009
Mailing Address - Fax:817-572-0221
Practice Address - Street 1:4101 JOHN DEERE ROAD
Practice Address - Street 2:SUITE #3
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-581-2016
Practice Address - Fax:309-581-2855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PROJECT OF THE QUAD CITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-26
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy