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General NPI Number Information
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NPI Number | 1376264366
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Entity Type | Organization
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Legal Business Name | QUAD CITIES INTERFAITH
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 3420 JERSEY RIDGE RD
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City | DAVENPORT
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State | IA
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Zip | 52807-2222
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Country | US
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Telephone | 563-241-2969
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 JERSEY RIDGE RD
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City | DAVENPORT
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State | IA
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Zip | 52807-2222
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Country | US
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Telephone | 563-241-2969
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AMBER BORDOLO
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Credential | MA
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Telephone | 563-241-2969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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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 | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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