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General NPI Number Information
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NPI Number | 1528426202
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Entity Type | Organization
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Legal Business Name | ROSECRANCE, INC.
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 2704 N MAIN ST
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City | ROCKFORD
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State | IL
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Zip | 61103-3112
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Country | US
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Telephone | 815-968-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 N MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61107-3877
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Country | US
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Telephone | 815-391-1000
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | PHILIP EATON
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Credential |
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Telephone | 815-387-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | A-0601-0044-A
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License Number State | IL
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