Organization
JANET WATTLES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHIL EATON (CEO/PRESIDENT)
(815) 968-9300
Entity
Organization
Contact information
Practice address
707 N COURT ST, ROCKFORD, IL 61103-6954
(815) 968-9300
Mailing address
526 W STATE ST, ROCKFORD, IL 61101-1214
(815) 968-9300
(815) 968-5314
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018
—
IL
01
—
10120962
BCBS
IL
Enumeration date
06/15/2011
Last updated
06/15/2011
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