KCCDD, INC. (NPI# 1881857514) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881857514 |
| Entity Type | Organization |
| Organization Name | KCCDD, INC. |
| Practice Address |
2015 Windish Dr Galesburg IL 61401-9774 |
| Practice Telephone | 3093442600 |
| Practice Fax Number | 3093441754 |
| Mailing Telephone | 3093442600 |
| Mailing Fax Number | 3093441754 |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2019-09-06 |
| Authorized Official Name | MR. MARK EDWIN RUDOLPH (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 3093442600 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | A000103309 | IL | Agencies |
| Y | 261QA0600X |
Clinic/Center Specialization: Adult Day Care |
Ambulatory Health Care Facilities |
| Street Address |
2015 WINDISH DR |
| City | GALESBURG |
| State | IL |
| Zip Code | 61401-9774 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679174973 | Jeff Engwall | Pharmacist | 359 Knox Square Drive, Galesburg, IL 61401 | 2020-11-03 |
| 1861962441 | Becky Cameron | Counselor | 2323 Windish Dr., Galesburg, IL 61401 | 2018-11-27 |
| 1295245496 | Aaron Thomas Wachtel | Dentist | 1172 Monroe Street, Galesburg, IL 61401 | 2017-10-03 |
| 1588182224 | Alicia Warren | Speech-Language Pathologist | 932 Harrison St., Galesburg, IL 61401 | 2017-09-01 |
| 1770986770 | Virginia G Kasser | Psychologist | 575 N Kellogg, Galesburg, IL 61401 | 2014-10-03 |
| 1063814309 | Lakshmi Kalyani Gudavalli | Physical Therapist | 275 E Carl Sandburg Drive, Marigold Rehabilitation, Galesburg, IL 61401 | 2014-09-18 |
| 1821350489 | James Eugene Tiller | Psychologist | 2101 Windish Drive, Galesburg, IL 61401 | 2012-06-11 |
| 1720285836 | Donald J. Regnier | Hearing Instrument Specialist | 4l Plaza, Suite 57, Galesburg, IL 61401 | 2007-07-02 |
| 1306066535 | Arnold John Minor | Dentist | 69 N Chambers St, Galesburg, IL 61401 | 2007-04-30 |
| 1114140373 | Community Residential Centers Inc | Intermediate Care Facility, Mentally Retarded | 239 S Cherry Street, Galesburg, IL 61401 | 2007-04-10 |
| Find all providers in zip 61401 | ||||
| Taxonomy Code | 261QA0600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Day Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962987735 | Osf Healthcare System | Clinic/Center | 719 N William Kumpf Blvd Ste 300, Peoria, IL 61605-2531 | 2018-09-27 |
| 1083190920 | St. John's Healing Community Board | Clinic/Center | 1015b Century Dr, Edwardsville, IL 62025-3772 | 2018-07-13 |
| 1922594613 | Northwest Adult Wellness Center LLC | Clinic/Center | 235 W 95th Suite 3, Chicago, IL 60628 | 2018-07-05 |
| 1871003335 | Center for Seniors | Clinic/Center | 8900 Capitol Dr, Wheeling, IL 60090-7203 | 2017-10-10 |
| 1336689322 | St. John's Lutheran Church, Inc. | Clinic/Center | 311 N. Lake Rd., Lena, IL 61048-8712 | 2017-02-24 |
| 1306398656 | Naperville Senior Center Adult Day Services | Clinic/Center | 1504 N Naper Blvd Ste 120, Naperville, IL 60563-4819 | 2016-11-02 |
| 1598218604 | 3ys Service, Inc | Clinic/Center | 914 E 54th St, Chicago, IL 60615-5018 | 2016-07-26 |
| 1962896431 | Presence Heritage Day Break | Clinic/Center | 1025 N Washington Ave, Kankakee, IL 60901-2059 | 2015-03-23 |
| 1700281011 | Starlight Adult Day Care Dba Forever Young Adult Day Services, Inc. | Clinic/Center | 6700 N Lincoln Ave, Lincolnwood, IL 60712-3607 | 2014-10-29 |
| 1588073753 | The Golden Years Adult Day Center LLC | Clinic/Center | 7 N 44th St, Belleville, IL 62226-5543 | 2014-08-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.