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General NPI Number Information
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NPI Number | 1023817475
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Entity Type | Organization
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Legal Business Name | SBH-DAVENPORT, LLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 770 TANGLEFOOT LN
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City | BETTENDORF
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State | IA
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Zip | 52722-1608
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Country | US
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Telephone | 563-396-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 770 TANGLEFOOT LN
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City | BETTENDORF
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State | IA
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Zip | 52722-1608
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Country | US
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Telephone | 563-396-2100
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Fax |
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Authorized Official
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Title or Position | CHIEF LEGAL OFFICER
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Name | PAUL GILBERT
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Credential |
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Telephone | 615-545-5519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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