NPIMap

Organization Active NPI

Rosecrance

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rockford, IL
National Provider Identifier
1790066082
Registry record updated Apr 27, 2018
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
ROSECRANCE
Practice address
1422 20TH St
Rockford, IL 61104-3519
Phone
(815) 391-1000
NPI assigned
Aug 31, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2018

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

Authorized official

Name
Phillip Eaton
Title
Ceo / President
Phone
(815) 391-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 04081 IL Primary

Addresses

Primary practice location

1422 20TH St
Rockford, IL 61104-3519

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
04081MedicaidIL

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

1422 20th St
Rockford, IL 61104
Phone (815) 968-9300

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": "1524787200000",
    "number": "1790066082",
    "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": "1422 20TH ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611043519",
            "telephone_number": "815-391-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSECRANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-31",
        "last_updated": "2018-04-27",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": "04081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04081",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.