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General NPI Number Information
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NPI Number | 1316218928
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Entity Type | Organization
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Legal Business Name | ALCOHOL & DRUG DEPENDENCY SERVICES
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 320 N. MAIN ST.
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City | DAVENPORT
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State | IA
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Zip | 52801
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Country | US
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Telephone | 563-322-1036
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Fax | 563-322-1086
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Provider Business Mailing Address
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Address Line | 1340 MT. PLEASANT ST.
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City | BURLINGTON
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State | IA
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Zip | 52601
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Country | US
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Telephone | 319-753-6567
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Fax | 319-753-0703
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. RICHARD SWANSON
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Credential | PH.D.
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Telephone | 319-753-6567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | IA
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