Provider Demographics
NPI:1235319518
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:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-786-6474
Mailing Address - Street 1:4016 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-6722
Mailing Address - Country:US
Mailing Address - Phone:309-786-6474
Mailing Address - Fax:309-786-9861
Practice Address - Street 1:4016 9TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-6722
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:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL92C158251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services