Quad Cities Interfaith

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

QUAD CITIES INTERFAITH

Practice address

3420 Jersey Ridge Rd
Davenport, IA 52807-2222

Phone

(563) 241-2969

NPI assigned

Sep 7, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amber Bordolo, MA

Title

Executive Director

Phone

(563) 241-2969

Specialties & licenses 3

Addresses

Other names 1

• Quad Cities Interfaith Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662508800000",
    "number": "1376264366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3420 JERSEY RIDGE RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072222",
            "telephone_number": "563-241-2969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3420 JERSEY RIDGE RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072222",
            "telephone_number": "563-241-2969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUAD CITIES INTERFAITH",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A",
        "authorized_official_last_name": "BORDOLO",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "563-241-2969",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quad Cities Interfaith",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.