ROSECRANCE NPI 1558642843

NPI Information

NPI: 1558642843
Provider Name: ROSECRANCE
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

CLIA Number: 14D2046529

Address:
2406 AUBURN ST
ROCKFORD, IL
ZIP 61103
Phone: (815) 391-1000
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ROSECRANCE is a mental health (including community mental health center) clinic center in Rockford, IL. ROSECRANCE NPI is 1558642843. The provider is registered as an organization entity type.

The provider's business location address is:

2406 AUBURN ST
ROCKFORD, IL
ZIP 61103-495
Phone: (815) 391-1000

The provider's authorized official is Phillip Eaton .
The authorized official title is Ceo / Presdient and has the following contact phone number (815) 391-1000.

The CLIA number assigned to this NPI record is 14D2046529 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/31/2011 and was last updated on 8/31/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	04081	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	04081	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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