Organization
REMEDIES RENEWING LIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY S. BRANNING (VP OF MARKETING/FUND DEVELOPMENT)
(815) 966-1285
Entity
Organization
Contact information
Practice address
215 EASTON PKWY, ROCKFORD, IL 61108
(815) 962-0871
(815) 962-7895
Mailing address
215 EASTON PKWY, ROCKFORD, IL 61108-2203
(815) 962-0871
(815) 962-7895
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
A-0559-0005-A
IL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A-0559-0005--A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
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—
IL
Enumeration date
04/17/2007
Last updated
07/29/2021
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