NPIMap

Organization Active NPI

Rosecrance, Inc.

  • Substance Abuse Rehabilitation Facility
  • Rockford, IL
National Provider Identifier
1194979237
Registry record updated Nov 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
ROSECRANCE, INC.
Practice address
3815 Harrison Ave
Detox A2 - 2ND Floor Northwest A2
Rockford, IL 61108-7631
Phone
(815) 391-1000
Fax
(815) 391-5040
NPI assigned
Nov 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2015

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

Authorized official

Name
Mr. Philip W. Eaton, MASTER OF SCIENCE
Title
Ceo / President
Phone
(815) 931-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

3815 Harrison Ave
Detox A2 - 2ND Floor Northwest A2
Rockford, IL 61108-7631

Mailing address

3815 Harrison Ave
Detox A2 - 2ND Floor Northwest A2
Rockford, IL 61108-7631
Phone (815) 391-1000

Other names 1

  • Rosecrance Harrison - Detox A2 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Inc97 organizations share this tax ID, including this one

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.

View all 24

Locations

3815 Harrison Ave
Fl 2
Rockford, IL 61108

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448409600000",
    "number": "1194979237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 HARRISON AVE",
            "address_2": "DETOX A2 - 2ND FLOOR NORTHWEST A2",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611087631",
            "telephone_number": "815-391-1000",
            "fax_number": "815-391-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 HARRISON AVE",
            "address_2": "DETOX A2 - 2ND FLOOR NORTHWEST A2",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611087631",
            "telephone_number": "815-391-1000",
            "fax_number": "815-391-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSECRANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2015-11-25",
        "status": "A",
        "authorized_official_last_name": "EATON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CEO / PRESIDENT",
        "authorized_official_telephone_number": "815-931-1000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MASTER OF SCIENCE"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rosecrance Harrison - Detox A2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 25, 2015; 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.

Verify at the official NPI Registry.