Healthcare Provider Details

I. General information

NPI: 1679437867
Provider Name (Legal Business Name): ROSECRANCE THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W OHIO ST STE 410E
CHICAGO IL
60654-6566
US

IV. Provider business mailing address

320 W OHIO ST STE 410E
CHICAGO IL
60654-6566
US

V. Phone/Fax

Practice location:
  • Phone: 815-391-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL VICK
Title or Position: CFO
Credential:
Phone: 815-387-5642