Individual
KERRY MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2701 17TH ST, ROCK ISLAND, IL 61201-5351
(309) 779-2957
Mailing address
1854 45TH ST, ROCK ISLAND, IL 61201-3952
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/07/2016
Last updated
12/07/2016
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