Healthcare Provider Details

I. General information

NPI: 1255744348
Provider Name (Legal Business Name): THE PROJECT OF THE QUAD CITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 RIVER DR STE 110
MOLINE IL
61265-1384
US

IV. Provider business mailing address

1701 RIVER DR STE 110
MOLINE IL
61265-1384
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-5433
  • Fax: 309-762-4481
Mailing address:
  • Phone: 309-762-5433
  • Fax: 309-762-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANDREA MEIRICK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 309-762-5433