Healthcare Provider Details

I. General information

NPI: 1770416596
Provider Name (Legal Business Name): KHALIL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1946 DAIMLER RD
ROCKFORD IL
61112-1008
US

IV. Provider business mailing address

1946 DAIMLER RD
ROCKFORD IL
61112-1008
US

V. Phone/Fax

Practice location:
  • Phone: 815-980-9416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MOHSIN KHAN
Title or Position: MANAGER
Credential: MD
Phone: 815-980-9416