| Kccdd, Inc. | |
|
2015 Windish Dr Galesburg IL 61401-9774 | |
| (309) 344-2600 | |
| (309) 344-1754 |
| Full Name | Kccdd, Inc. |
|---|---|
| Speciality | Clinic/center - Adult Day Care |
| Location | 2015 Windish Dr, Galesburg, Illinois |
| Authorized Official Name and Position | Mark Edwin Rudolph (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3093442600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kccdd, Inc. 2015 Windish Dr Galesburg IL 61401-9774 Ph: (309) 344-2600 | Kccdd, Inc. 2015 Windish Dr Galesburg IL 61401-9774 Ph: (309) 344-2600 |
| NPI Number | 1881857514 |
|---|---|
| Provider Enumeration Date | 07/02/2008 |
| Last Update Date | 09/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881857514 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | A000103309 (Illinois) | Secondary |
| 261QA0600X | Clinic/center - Adult Day Care | (* (Not Available)) | Primary |
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