=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205143351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-COUNTY OPPORTUNITIES COUNCIL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2010
-----------------------------------------------------
Last Update Date | 09/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 EMMONS AVE
-----------------------------------------------------
City | ROCK FALLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61071-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-625-7830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 EMMONS AVE P.O. BOX 610
-----------------------------------------------------
City | ROCK FALLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61071-1407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-625-7830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MS. SANDRA JULIFS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-625-7830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------