Organization
ROSECRANCE, INC.
Active
Other names
Rosecrance Berry Campus
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP EATON (CEO / PRESIDENT)
(815) 391-1000
Entity
Organization
Contact information
Practice address
8616 NORTHERN AVE, ROCKFORD, IL 61107-5309
(815) 391-1000
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
04081
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04081
—
IL
05
—
A-0601-0037-A
—
IL
Enumeration date
08/26/2011
Last updated
06/27/2017
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