Active NPI
Rosecrance
Doing business as Rosecrance Auburn Supervised Living
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Rockford, IL
National Provider Identifier
1275814568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- License
- 04081
- Legal business name
- ROSECRANCE
- Doing business as
- Rosecrance Auburn Supervised Living
- Practice address
- 2014 Auburn St
Rockford, IL 61103-4479 - Phone
- (815) 391-1000
- NPI assigned
- Aug 31, 2011
- Last updated
- Dec 8, 2015
- 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
- Mr. Phillip Eaton
- Title
- Ceo / President
- Phone
- (815) 391-1000
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 04081 | IL | Primary |
| Mental Illness Community Based Residential Treatment Facility | 320800000X | NU |
Addresses
Primary practice location
2014 Auburn St
Rockford, IL 61103-4479
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 Auburn Supervised Living
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
- Rosecrance 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
-
- Primary Care Clinic/Center
- Rockford, IL
- NPI 1164174140
-
dba Rosecrance Dakota Clinic
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Crystal Lake, IL
- NPI 1134575558
-
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
-
dba Rosecrance Swedish American Collaboration
- Psychiatric Hospital Unit
- Rockford, IL
- NPI 1205279692
-
dba Rosecrance Harrison - Women's
- Substance Abuse Rehabilitation Facility
- Rockford, IL
- NPI 1245216050
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Champaign, IL
- NPI 1265880694
-
dba Rosecrance Mulberry
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Rockford, IL
- NPI 1285040865
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Champaign, IL
- NPI 1285081653
-
dba Rosecrance Harrison - Detox A1
- Substance Abuse Rehabilitation Facility
- Rockford, IL
- NPI 1295713824
-
dba Rosecrance Oak Park Office
- Substance Use Disorder Rehabilitation Clinic/Center
- Oak Park, IL
- NPI 1306182043
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Clinical Social Worker
- Champaign, IL
- NPI 1457979676
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314748800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1449532800000",
"number": "1275814568",
"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": "815-316-4726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2014 AUBURN ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611034479",
"telephone_number": "815-391-1000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ROSECRANCE",
"organizational_subpart": "NO",
"enumeration_date": "2011-08-31",
"last_updated": "2015-12-08",
"status": "A",
"authorized_official_last_name": "EATON",
"authorized_official_first_name": "PHILLIP",
"authorized_official_title_or_position": "CEO / PRESIDENT",
"authorized_official_telephone_number": "815-391-1000",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": "IL",
"license": "04081",
"primary": true
},
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04081",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Rosecrance Auburn Supervised Living",
"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 Dec 8, 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.