MEDICARE: ROSECRANCE THERAPIES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1679437867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSECRANCE THERAPIES, LLC

Provider Business Mailing Address
First Line	:	320 W OHIO ST STE 410E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-6566
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 W OHIO ST STE 410E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-6566
Country	:	US
Telephone Number	:	815-391-1000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL VICK
Credential	:
Telephone Number	:	815-391-5642

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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