Organization
ROSECRANCE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA NICOLE PRIMM (VP OF PAYER RELATIONS)
(815) 391-1000
Entity
Organization
Contact information
Practice address
5440 N CUMBERLAND AVE STE 165, CHICAGO, IL 60656-4708
(815) 391-1000
Mailing address
1021 N MULFORD RD, ROCKFORD, IL 61107-3877
(815) 387-5600
(815) 316-4726
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
A-0601-0052-A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A-0601-0052-A
DASA LICENSE
IL
Enumeration date
09/15/2017
Last updated
12/11/2023
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