Organization
ROSECRANCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHIL EATON MBS (CEO / PRESIDENT)
(815) 391-1000
Entity
Organization
Contact information
Practice address
801 N WALNUT ST, CHAMPAIGN, IL 61820
(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
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04081
—
IL
Enumeration date
05/26/2016
Last updated
07/02/2019
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