Healthcare Provider Details

I. General information

NPI: 1780588863
Provider Name (Legal Business Name): FAMILY LEGACY ADULT CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 ALLIANCE AVE
ROCKFORD IL
61101-5510
US

IV. Provider business mailing address

420 ALLIANCE AVE
ROCKFORD IL
61101-5510
US

V. Phone/Fax

Practice location:
  • Phone: 815-310-5581
  • Fax:
Mailing address:
  • Phone: 815-310-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. SHAREE SIMMONS
Title or Position: NURSE
Credential: RN
Phone: 815-289-0096