Basic Information
| Provider Information | |||||||||
| NPI: | 1245480060 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROSECRANCE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611075317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153911000 | ||||||||
| FaxNumber: | 8153915040 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 S JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | JANESVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535483837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087528716 | ||||||||
| FaxNumber: | 8153915040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 07/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | EATON | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO / PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8153911000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MASTERS OF SCIENCE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 42254500 | 05 | WI | MEDICAID |