MEDICARE: ROSECRANCE, INC.

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	324500000X	Substance Abuse Rehabilitation Facility	A-0601-0029-A	IL
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770734352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSECRANCE, INC.

Provider Business Mailing Address
First Line	:	1021 N MULFORD RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3877
Country	:	US
Telephone Number	:	815-391-1000
Fax Number	:	815-391-5040

Provider Business Practice Location Address
First Line	:	20635 ABBEY WOODS CT N
Second Line	:	SUITE #310 B
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3181
Country	:	US
Telephone Number	:	815-391-1000
Fax Number	:	815-391-5040

Authorized Official
Title or Position	:	CEO
Name	:	MR. PHIL W. EATON
Credential	:	MASTERS IN SCIENCE
Telephone Number	:	815-391-1000

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	04/25/2018

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Directions to “ROSECRANCE, INC. ” Practice Location

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