Healthcare Provider Details

I. General information

NPI: 1942870928
Provider Name (Legal Business Name): STEPPING STONES OF ROCKFORD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4317 MARAY DR
ROCKFORD IL
61107-4967
US

IV. Provider business mailing address

706 N MAIN ST
ROCKFORD IL
61103-6904
US

V. Phone/Fax

Practice location:
  • Phone: 815-963-0883
  • Fax:
Mailing address:
  • Phone: 815-963-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CANDICE O'BRIEN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 815-963-0683