Healthcare Provider Details

I. General information

NPI: 1376455394
Provider Name (Legal Business Name): ELIJAH J ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 41ST ST
MOLINE IL
61265-7859
US

IV. Provider business mailing address

3000 41ST ST
MOLINE IL
61265-7859
US

V. Phone/Fax

Practice location:
  • Phone: 563-650-2650
  • Fax:
Mailing address:
  • Phone: 563-650-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: