Healthcare Provider Details

I. General information

NPI: 1033527247
Provider Name (Legal Business Name): STEPPING STONES OF ROCKFORD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 GLENWOOD AVE
ROCKFORD IL
61101-3542
US

IV. Provider business mailing address

706 N MAIN ST
ROCKFORD IL
61103-6904
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number04130
License Number StateIL

VIII. Authorized Official

Name: CANDICE D O'BRIEN
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 815-742-0527