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NPI Code Detail

MEDICARE: ROSECRANCE INC

MEDICARE: ROSECRANCE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1356327340
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROSECRANCE INC
Provider Business Mailing Address
First Line : 1021 N MULFORD RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-3877
Country : US
Telephone Number : 815-391-0100
Fax Number : 815-391-5040
Provider Business Practice Location Address
First Line : 1601 UNIVERSITY DR
Second Line : ROSECRANCE INC GRIFFIN WILLIAMSON
City : ROCKFORD
State : IL
Zip : 61107-5317
Country : US
Telephone Number : 815-391-1000
Fax Number : 815-484-8640
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MR. PHILLIP W EATON
Credential : MS
Telephone Number : 815-391-0100
Provider Enumeration Date : 12/21/2005
Last Update Date : 07/01/2019

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Directions to “ROSECRANCE INC ” Practice Location

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