=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447165469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUAD CITIES INTERVENTION SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2026
-----------------------------------------------------
Last Update Date | 08/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 41ST ST
-----------------------------------------------------
City | MOLINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61265-7859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-269-2591
-----------------------------------------------------
Fax | 309-269-2591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1019 23RD AVE
-----------------------------------------------------
City | MOLINE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61265-4771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-269-2591
-----------------------------------------------------
Fax | 309-269-2591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIDGETT YVONNE ALLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 309-269-2591
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3245S0500X
-----------------------------------------------------
Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------