Provider Demographics
NPI:1568459709
Name:ROSECRANCE INC
Entity Type:Organization
Organization Name:ROSECRANCE INC
Other - Org Name:ROSECRANCE HARRISON - OUTPATIENT
Other - Org Type:Doing Business As
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 1:3815 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-7631
Mailing Address - Country:US
Mailing Address - Phone:815-391-0100
Mailing Address - Fax:
Practice Address - Street 1:3815 HARRISON AVE
Practice Address - Street 2:OUTPATIENT
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-7631
Practice Address - Country:US
Practice Address - Phone:815-391-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0601OtherDEPT OF HUMAN SERVICES
IL0601OtherDEPT OF HUMAN SERVICES
HC0837OtherJCAHO