Healthcare Provider Details

I. General information

NPI: 1255799938
Provider Name (Legal Business Name): ROSECRANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MULBERRY ST
ROCKFORD IL
61103-6746
US

IV. Provider business mailing address

1021 N MULFORD RD
ROCKFORD IL
61107-3877
US

V. Phone/Fax

Practice location:
  • Phone: 815-720-4960
  • Fax: 815-312-5770
Mailing address:
  • Phone: 815-391-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberA-0601-0044-A
License Number StateIL

VIII. Authorized Official

Name: PHILIP EATON
Title or Position: CEO/PRESIDENT
Credential:
Phone: 815-387-5600