Organization
ROSECRANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHIL EATON (CEO/PRESIDENT)
(815) 391-1000
Entity
Organization
Contact information
Practice address
650 W STATE ST, ROCKFORD, IL 61102-2201
(815) 391-1000
(815) 316-4726
Mailing address
1021 N MULFORD RD, ROCKFORD, IL 61107-3877
(815) 391-1000
(815) 316-4726
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
12/04/2013
Last updated
12/05/2013
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