Organization
CHANGES PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK PHILLIPS CADC (ADMINISTRATOR)
(815) 316-0699
Entity
Organization
Contact information
Practice address
258 N PHELPS AVE, ROCKFORD, IL 61108-2433
(815) 316-0699
(815) 316-0698
Mailing address
258 N PHELPS AVE, ROCKFORD, IL 61108-2433
(815) 316-0699
(815) 316-0698
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A47410002A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A47410001A
LICENSED OUTPATIENT SUBSTANCE ABUSE TREATMENT PROVIDER
IL
01
—
A47410002A
LICENSED OUTPATIENT SUBSTANCE ABUSE TREATMENT PROVIDER
IL
Enumeration date
07/10/2008
Last updated
07/10/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up