1649519620 NPI number — THE GOOD SHEPHERD FOUNDATION OF HENRY COUNTY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649519620 NPI number — THE GOOD SHEPHERD FOUNDATION OF HENRY COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GOOD SHEPHERD FOUNDATION OF HENRY COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649519620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4711 44TH STREET
Provider Second Line Business Mailing Address:
4711 44TH STREET, SUITE 2
Provider Business Mailing Address City Name:
ROCK ISLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61201-7190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-944-6205
Provider Business Mailing Address Fax Number:
309-944-3258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4711 44TH STREET
Provider Second Line Business Practice Location Address:
4711 44TH STREET, SUITE 2
Provider Business Practice Location Address City Name:
ROCK ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61201-7190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-270-1741
Provider Business Practice Location Address Fax Number:
309-755-9710
Provider Enumeration Date:
02/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTENSEN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL PROGRAM DIRECTOR
Authorized Official Telephone Number:
309-270-1741

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  A-9103-0002-A , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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