Healthcare Provider Details

I. General information

NPI: 1568459709
Provider Name (Legal Business Name): ROSECRANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 HARRISON AVE OUTPATIENT
ROCKFORD IL
61108-7631
US

IV. Provider business mailing address

3815 HARRISON AVE
ROCKFORD IL
61108-7631
US

V. Phone/Fax

Practice location:
  • Phone: 815-391-0100
  • Fax:
Mailing address:
  • Phone: 815-391-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILIP W EATON
Title or Position: PRESIDENT CEO
Credential: MASTER OF SCIENCE
Phone: 815-391-0100