NPIMap

Organization Active NPI

Rosecrance Inc

Doing business as Rosecrance Harrison - Outpatient

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Rockford, IL
National Provider Identifier
1568459709
Registry record updated Apr 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
ROSECRANCE INC
Doing business as
Rosecrance Harrison - Outpatient
Practice address
3815 Harrison Ave
Outpatient
Rockford, IL 61108-7631
Phone
(815) 391-0100
NPI assigned
Oct 3, 2005
Last updated
Apr 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2018

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
President Ceo
Phone
(815) 391-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary

Addresses

Primary practice location

3815 Harrison Ave
Outpatient
Rockford, IL 61108-7631

Mailing address

3815 Harrison Ave
Rockford, IL 61108-7631
Phone (815) 391-0100

Other identifiers 1

IdentifierTypeStateIssuer
0601OtherILDEPT OF HUMAN SERVICES

Other names 1

  • Rosecrance Harrison - Outpatient 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
Rosecrance 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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1568459709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 HARRISON AVE",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611087631",
            "telephone_number": "815-391-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 HARRISON AVE",
            "address_2": "OUTPATIENT",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611087631",
            "telephone_number": "815-391-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSECRANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "EATON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "815-391-0100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MASTER OF SCIENCE"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF HUMAN SERVICES",
            "identifier": "0601",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rosecrance Harrison - Outpatient",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rosecrance Harrison - Outpatient",
            "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 Apr 26, 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.

Verify at the official NPI Registry.