Kerry Mendoza

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Practice address

2701 17TH St
Rock Island, IL 61201-5351

Phone

(309) 779-2957

NPI assigned

Dec 7, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1481068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481068800000",
    "number": "1881138071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1854 45TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612013952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 17TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015351",
            "telephone_number": "309-779-2957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "KERRY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-12-07",
        "last_updated": "2016-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Michelle McNelis, LCSW
• Melissa M McNicholas, M.S. DEV PSY
• Susan E Medinger, RN
• Amanda Meegan
• Martha Meg Mellecker, RPH, PHARMD
• Richard Stavros Mento, D.C.
• Thais Meredith, D.M.D.
• Scott David Meskimen, CPNP
• Shannon Mess
• Jane A Meyer, MNT

• Mental Illness Community Based Residential Treatment Facility in Rock Island, IL
• Providers in Rock Island, IL by specialty
• Mental Illness Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.