Healthcare Provider Details

I. General information

NPI: 1043058605
Provider Name (Legal Business Name): THE ROBERT YOUNG CENTER FOR COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 3RD AVE
ROCK ISLAND IL
61201-8840
US

IV. Provider business mailing address

4600 3RD ST
MOLINE IL
61265-6106
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-2094
  • Fax: 309-779-2819
Mailing address:
  • Phone: 309-779-3000
  • Fax: 309-779-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN SANCHEZ
Title or Position: MANAGER BUSINESS/BILLING OPERATIONS
Credential:
Phone: 309-382-8017