Organization
ROSECRANCE INC
Active
Organization
ROSECRANCE INC
Active
Other names
Rosecrance Harrison - Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP W EATON MASTER OF SCIENCE (PRESIDENT CEO)
(815) 391-0100
Entity
Organization
Contact information
Practice address
3815 HARRISON AVE, OUTPATIENT, ROCKFORD, IL 61108-7631
(815) 391-0100
Mailing address
3815 HARRISON AVE, ROCKFORD, IL 61108-7631
(815) 391-0100
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0601
DEPT OF HUMAN SERVICES
IL
Enumeration date
10/03/2005
Last updated
04/26/2018
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