Healthcare Provider Details

I. General information

NPI: 1164174140
Provider Name (Legal Business Name): ROSECRANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N MAIN ST
ROCKFORD IL
61103-3112
US

IV. Provider business mailing address

1021 N MULFORD RD
ROCKFORD IL
61107-3874
US

V. Phone/Fax

Practice location:
  • Phone: 815-968-9300
  • Fax:
Mailing address:
  • Phone: 815-387-1000
  • Fax: 815-316-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN FRANCIS SCHUSTER
Title or Position: CFO
Credential:
Phone: 815-387-5642