Organization
ROSECRANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP EATON MBA (CEO / PRESIDENT)
(815) 391-1000
Entity
Organization
Contact information
Practice address
10950 W FOREST HOME AVE, HALES CORNERS, WI 53130-2556
(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
2987
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2987
LICENSE
WI
Enumeration date
10/16/2015
Last updated
02/01/2016
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