1831716745 NPI number — THE PROJECT OF THE QUAD CITIES

Table of content: (NPI 1831716745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831716745 NPI number — THE PROJECT OF THE QUAD CITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PROJECT OF THE QUAD CITIES
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:
6
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:
1831716745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1620 W. NORTHWEST HWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-572-0009
Provider Business Mailing Address Fax Number:
817-572-0221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 JOHN DEERE ROAD
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-581-2016
Provider Business Practice Location Address Fax Number:
309-581-2855
Provider Enumeration Date:
06/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WELLS
Authorized Official First Name:
CAITLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
503-964-4036

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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