Rosecrance Inc
Organization Active NPI Substance Abuse Rehabilitation Facility · Rockford, IL
NPI 1295713824 · NPPES record last updated Nov 25, 2015
Key facts
- NPI
- 1295713824
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- ROSECRANCE INC
- Practice address
- 3815 Harrison Ave
Rosecrance on Harrison - 2ND Floor Northwest
Rockford, IL 61108-7631 - Phone
- (815) 391-1000
- Fax
- (815) 484-8640
- NPI assigned
- Jan 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Phillip W Eaton, MS
- Title
- President/Ceo
- Phone
- (815) 391-0100
Corporate family (same tax ID) 24
Practitioners 3
-
Arturo Gudino Jr., PH.D.
-
Meghan Cook, LSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| 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
- Tax ID family
- Roscrance Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
3815 Harrison Ave
Rosecrance on Harrison - 2ND Floor Northwest
Rockford, IL 61108-7631
Mailing address
1021 N Mulford Rd
Rockford, IL 61107-3877
Phone (815) 391-0100
Other names
- Rosecrance Harrison - Detox A1
Other providers in Rockford, IL
- Rosecrance
- Rosecrance Inc
- Rosecrance Inc
- Rosecrance Inc
- Rosecrance Inc
- Rosecrance Inc
- Rosecrance Inc
- Rosecrance Inc
- Rosecrance Inc
- Rosecrance Inc
All providers in Rockford, IL · Substance Abuse Rehabilitation Facility in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.