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General NPI Number Information
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NPI Number | 1790909984
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Entity Type | Organization
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Legal Business Name | MILESTONE, INC.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 2642 ELMWOOD RD
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City | ROCKFORD
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State | IL
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Zip | 61103-1573
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Country | US
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Telephone | 815-639-2741
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Fax |
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Provider Business Mailing Address
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Address Line | 4060 MCFARLAND RD
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City | LOVES PARK
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State | IL
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Zip | 61111-4402
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Country | US
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Telephone | 815-654-6100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & C.E.O.
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Name | MR. WILLIAM C. GRAHN
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Credential |
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Telephone | 815-639-2817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 003
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License Number State | IL
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