Active NPI
Tri-County Alcohol and Drug Services LLC
- Clinic/Center
- East Moline, IL
National Provider Identifier
1356640346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- A-8601-0002-A
- Legal business name
- TRI-COUNTY ALCOHOL AND DRUG SERVICES LLC
- Practice address
- 926 15TH Ave
East Moline, IL 61244-2138 - Phone
- (309) 752-9740
- Fax
- (309) 752-9744
- NPI assigned
- Mar 16, 2011
- Organization subpart
- Yes
- Parent organization
- TRI-COUNTY ALCOHOL AND DRUG SERVICES LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jeffrey A Edwards, MDIV, CADC
- Title
- Manager/Counselor
- Phone
- (309) 752-9740
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | A-8601-0002-A | IL | Primary |
Addresses
Primary practice location
926 15TH Ave
East Moline, IL 61244-2138
Mailing address
926 15TH Ave
East Moline, IL 61244-2138
Phone (309) 752-9740
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2575259 | Other | IL | CIGNA BEHAVIORAL HEALTH |
| 9510564 | Other | IL | MULTIPLAN |
National Provider Directory
National Provider Directory- Part of
- Tri-County Alcohol and Drug Services LLC
Locations
926 15th Ave
East Moline, IL 61244
Phone (309) 752-9740
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Addiction (Substance Use Disorder) Counselor
- East Moline, IL
- NPI 1376731000
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300233600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1300233600000",
"number": "1356640346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "926 15TH AVE",
"city": "EAST MOLINE",
"state": "IL",
"postal_code": "612442138",
"telephone_number": "309-752-9740",
"fax_number": "309-752-9744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "926 15TH AVE",
"city": "EAST MOLINE",
"state": "IL",
"postal_code": "612442138",
"telephone_number": "309-752-9740",
"fax_number": "309-752-9744"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRI-COUNTY ALCOHOL AND DRUG SERVICES LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TRI-COUNTY ALCOHOL AND DRUG SERVICES LLC",
"enumeration_date": "2011-03-16",
"last_updated": "2011-03-16",
"status": "A",
"authorized_official_last_name": "EDWARDS",
"authorized_official_first_name": "JEFFREY",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "MANAGER/COUNSELOR",
"authorized_official_telephone_number": "309-752-9740",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "MDIV, CADC"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "IL",
"license": "A-8601-0002-A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA BEHAVIORAL HEALTH",
"identifier": "2575259",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "9510564",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Moline, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.