Healthcare Provider Details

I. General information

NPI: 1770734352
Provider Name (Legal Business Name): ROSECRANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20635 ABBEY WOODS CT N SUITE #310 B
FRANKFORT IL
60423-3181
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: 815-391-1000
  • Fax: 815-391-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA-0601-0029-A
License Number StateIL

VIII. Authorized Official

Name: MR. PHIL W. EATON
Title or Position: CEO
Credential: MASTERS IN SCIENCE
Phone: 815-391-1000