1891227575 NPI number — THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH

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 1891227575 NPI number — THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH
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:
1891227575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5078
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK ISLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61204-5078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-779-2031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12200 104TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COAL VALLEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61240-9712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-799-7044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DUKE
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
309-779-2043

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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