Provider Demographics
NPI:1245480060
Name:ROSECRANCE, INC.
Entity type:Organization
Organization Name:ROSECRANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
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:MASTERS OF SCIENCE
Authorized Official - Phone:815-391-1000
Mailing Address - Street 1:1601 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:815-391-5040
Practice Address - Street 1:54 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3837
Practice Address - Country:US
Practice Address - Phone:608-752-8716
Practice Address - Fax:815-391-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42254500Medicaid