NPIMap

Organization Active NPI

Rosecrance, Inc.

  • Substance Abuse Rehabilitation Facility
  • Rockford, IL
National Provider Identifier
1962671701
Registry record updated Nov 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
A-0601-0002-A Issued in IL
Legal business name
ROSECRANCE, INC.
Practice address
3522 Green Dale Dr
Rockford, IL 61109-1575
Phone
(815) 391-5095
Fax
(815) 484-4750
NPI assigned
Feb 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2015

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

Authorized official

Name
Mr. Philip W. Eaton, MASTERS IN SCIENCE
Title
President/Ceo
Phone
(815) 391-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X A-0601-0002-A IL Primary

Addresses

Primary practice location

3522 Green Dale Dr
Rockford, IL 61109-1575

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
A-0601-0002-AMedicaidIL

Other names 1

  • Rosecrance Greendale House Doing business as

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 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448409600000",
    "number": "1962671701",
    "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": "815-391-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3522 GREEN DALE DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611091575",
            "telephone_number": "815-391-5095",
            "fax_number": "815-484-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSECRANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2015-11-25",
        "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": "815-391-1000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MASTERS IN SCIENCE"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "IL",
            "license": "A-0601-0002-A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A-0601-0002-A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rosecrance Greendale 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 Nov 25, 2015; 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.