Organization
KCCDD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK EDWIN RUDOLPH (CHIEF EXECUTIVE OFFICER)
(309) 344-2600
Entity
Organization
Contact information
Practice address
2015 WINDISH DR, GALESBURG, IL 61401-9774
(309) 344-2600
(309) 344-1754
Mailing address
2015 WINDISH DR, GALESBURG, IL 61401-9774
(309) 344-2600
(309) 344-1754
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
A000103309
IL
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
07/02/2008
Last updated
09/06/2019
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