Healthcare Provider Details

I. General information

NPI: 1649519620
Provider Name (Legal Business Name): THE GOOD SHEPHERD FOUNDATION OF HENRY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 44TH STREET 4711 44TH STREET, SUITE 2
ROCK ISLAND IL
61201-7190
US

IV. Provider business mailing address

4711 44TH STREET 4711 44TH STREET, SUITE 2
ROCK ISLAND IL
61201-7190
US

V. Phone/Fax

Practice location:
  • Phone: 309-270-1741
  • Fax: 309-755-9710
Mailing address:
  • Phone: 309-944-6205
  • Fax: 309-944-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA-9103-0002-A
License Number StateIL

VIII. Authorized Official

Name: RONALD CHRISTENSEN
Title or Position: CLINICAL PROGRAM DIRECTOR
Credential: ED.D, CADC
Phone: 309-270-1741