Provider Demographics
NPI:1902840325
Name:STEPPING STONES OF ROCKFORD, INC
Entity Type:Organization
Organization Name:STEPPING STONES OF ROCKFORD, INC
Other - Org Name:RIVER NORTH OF ROCKFORD, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPHA
Authorized Official - Phone:815-963-0683
Mailing Address - Street 1:706 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-6904
Mailing Address - Country:US
Mailing Address - Phone:815-963-0683
Mailing Address - Fax:
Practice Address - Street 1:4505 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-5207
Practice Address - Country:US
Practice Address - Phone:815-963-0683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0413320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========008Medicaid