Provider Demographics
NPI:1558599803
Name:ROSECRANCE, INC.
Entity Type:Organization
Organization Name:ROSECRANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER OF SCIENCE
Authorized Official - Phone:815-391-0100
Mailing Address - Street 1:1601 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5317
Mailing Address - Country:US
Mailing Address - Phone:815-391-1000
Mailing Address - Fax:815-394-5041
Practice Address - Street 1:215 N. COURT STREET
Practice Address - Street 2:METHODIST CHURCH
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-6802
Practice Address - Country:US
Practice Address - Phone:815-391-1000
Practice Address - Fax:815-391-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-0601-0026-A3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-0601-0026-AMedicaid