Healthcare Provider Details

I. General information

NPI: 1790909984
Provider Name (Legal Business Name): MILESTONE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 ELMWOOD RD
ROCKFORD IL
61103-1573
US

IV. Provider business mailing address

4060 MCFARLAND RD
LOVES PARK IL
61111-4402
US

V. Phone/Fax

Practice location:
  • Phone: 815-639-2741
  • Fax:
Mailing address:
  • Phone: 815-654-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number003
License Number StateIL

VIII. Authorized Official

Name: MR. WILLIAM C. GRAHN
Title or Position: PRESIDENT & C.E.O.
Credential:
Phone: 815-639-2817