NPIMap

Organization Active NPI

Janet Wattles Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockford, IL
National Provider Identifier
1124313465
Registry record updated Jun 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
JANET WATTLES CENTER
Practice address
1422 20TH St
Rockford, IL 61104-3519
Phone
(815) 968-9300
NPI assigned
Jun 15, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Phil Eaton
Title
Ceo/President
Phone
(815) 968-9300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1422 20TH St
Rockford, IL 61104-3519

Mailing address

526 W State St
Rockford, IL 61101-1214
Phone (815) 968-9300

Other identifiers 2

IdentifierTypeStateIssuer
009MedicaidIL
10120962OtherILBCBS

National Provider Directory

National Provider Directory
Tax ID family
Janet Wattles Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308096000000",
    "number": "1124313465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611011214",
            "telephone_number": "815-968-9300",
            "fax_number": "815-968-5314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1422 20TH ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611043519",
            "telephone_number": "815-968-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JANET WATTLES CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-15",
        "last_updated": "2011-06-15",
        "status": "A",
        "authorized_official_last_name": "EATON",
        "authorized_official_first_name": "PHIL",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "815-968-9300"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "10120962",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.