Healthcare Provider Details

I. General information

NPI: 1861901043
Provider Name (Legal Business Name): ROSECRANCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LEE ST
DES PLAINES IL
60016-4539
US

IV. Provider business mailing address

1021 N MULFORD RD
ROCKFORD IL
61107-3877
US

V. Phone/Fax

Practice location:
  • Phone: 815-391-1000
  • Fax: 815-391-5040
Mailing address:
  • Phone: 815-387-5600
  • Fax: 815-316-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberA-0601-0052-A
License Number StateIL

VIII. Authorized Official

Name: PHILIP W. EATON
Title or Position: CEO
Credential:
Phone: 815-387-5600