Active NPI
Rosecrance Inc
Doing business as Rosecrance Dakota Clinic
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Crystal Lake, IL
National Provider Identifier
1134575558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Legal business name
- ROSECRANCE INC
- Doing business as
- Rosecrance Dakota Clinic
- Practice address
- 620 Dakota St
Crystal Lake, IL 60012 - Phone
- (815) 391-1000
- Fax
- (815) 316-4726
- NPI assigned
- May 5, 2016
- Last updated
- Sep 5, 2018
- Organization subpart
- No
NPPES NPI Registry
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) 391-1000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Primary |
Addresses
Primary practice location
620 Dakota St
Crystal Lake, IL 60012
Mailing address
1021 N Mulford Rd
Rockford, IL 61107-3877
Phone (815) 391-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04081 | Medicaid | IL |
Other names 1
- Rosecrance Dakota Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130502000371 | IL | Part B Supplier - Clinic/Group Practice | 3779656582 |
Receives reassigned benefits from 92 practitioners This NPI is an additional NPI on the enrollment Practice locations: La Grange, IL; Rockford, IL; McHenry, IL; Moline, IL; Northbrook, IL; Urbana, IL; Warrenville, IL; Chicago, IL… |
National Provider Directory
National Provider Directory- Tax ID family
- Roscrance Inc
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba Rosecrance Griffin Willaimson
- Substance Abuse Rehabilitation Facility
- Rockford, IL
- NPI 1174051031
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Chicago, IL
- NPI 1063891646
-
- Primary Care Clinic/Center
- Rockford, IL
- NPI 1164174140
-
dba Rosecrance Auburn Supervised Living
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Rockford, IL
- NPI 1275814568
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Urbana, IL
- NPI 1013364454
-
dba Rosecrance
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Freeport, IL
- NPI 1023764693
-
- Substance Abuse Rehabilitation Facility
- Champaign, IL
- NPI 1043774037
-
- Substance Abuse Rehabilitation Facility
- La Grange, IL
- NPI 1053762344
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Champaign, IL
- NPI 1083061469
-
dba Rosecrance Crystal Lake
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Crystal Lake, IL
- NPI 1124449731
-
dba Rosecrance McHenry County
- Mental Health Clinic/Center (Including Community Mental Health Center)
- McHenry, IL
- NPI 1144585803
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kankakee, IL
- NPI 1194425702
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462406400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1536105600000",
"number": "1134575558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 N MULFORD RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611073877",
"telephone_number": "815-391-1000",
"fax_number": "815-316-2746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 DAKOTA ST",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "60012",
"telephone_number": "815-391-1000",
"fax_number": "815-316-4726"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROSECRANCE INC",
"organizational_subpart": "NO",
"enumeration_date": "2016-05-05",
"last_updated": "2018-09-05",
"status": "A",
"authorized_official_last_name": "EATON",
"authorized_official_first_name": "PHIL",
"authorized_official_title_or_position": "CEO / PRESIDENT",
"authorized_official_telephone_number": "815-391-1000"
},
"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": "04081",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Rosecrance Dakota Clinic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Rosecrance Dakota Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.