NPIMap

Organization Active NPI

Roscrance Inc.

Doing business as Rosecrance Harbor House

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockford, IL
National Provider Identifier
1588945869
Registry record updated Dec 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
04081 Issued in IL
Legal business name
ROSCRANCE INC.
Doing business as
Rosecrance Harbor House
Practice address
707 N Court St
Rockford, IL 61103-6954
Phone
(815) 391-1000
NPI assigned
Aug 31, 2011
Last updated
Dec 4, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2015

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)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 04081 IL Primary
Mental Illness Community Based Residential Treatment Facility 320800000X

Addresses

Primary practice location

707 N Court St
Rockford, IL 61103-6954

Mailing address

1021 N Mulford Rd
Rockford, IL 61107-3877
Phone (815) 391-1000

Other identifiers 1

IdentifierTypeStateIssuer
04081MedicaidIL

Other names 1

  • Rosecrance Harbor House 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 3

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": "1314748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449187200000",
    "number": "1588945869",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N COURT ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611036954",
            "telephone_number": "815-391-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSCRANCE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-31",
        "last_updated": "2015-12-04",
        "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": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04081",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rosecrance Harbor House",
            "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 4, 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.