Healthcare Provider Details

I. General information

NPI: 1699866681
Provider Name (Legal Business Name): ROCK VALLEY WOMEN'S HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6861 VILLAGREEN VW
ROCKFORD IL
61107-5639
US

IV. Provider business mailing address

6861 VILLAGREEN VW
ROCKFORD IL
61107-5639
US

V. Phone/Fax

Practice location:
  • Phone: 815-637-6200
  • Fax: 815-637-1998
Mailing address:
  • Phone: 815-637-6200
  • Fax: 815-637-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0030559-6
License Number StateIL

VIII. Authorized Official

Name: MRS. LEE A JOHNSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 815-637-6200