| Rosecrance Berry Campus | |
|
8616 Northern Ave Rockford IL 61107-5309 | |
| (815) 391-1000 | |
| Not Available |
| Full Name | Rosecrance Berry Campus |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 8616 Northern Ave, Rockford, Illinois |
| Authorized Official Name and Position | Phillip Eaton (CEO / PRESIDENT) |
| Authorized Official Contact | 8153911000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rosecrance Berry Campus 1021 N Mulford Rd Rockford IL 61107-3877 Ph: (815) 391-1000 | Rosecrance Berry Campus 8616 Northern Ave Rockford IL 61107-5309 Ph: (815) 391-1000 |
| NPI Number | 1669752275 |
|---|---|
| Provider Enumeration Date | 08/26/2011 |
| Last Update Date | 06/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669752275 | NPI | - | NPPES |
| A-0601-0037-A | Medicaid | IL | |
| 04081 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 04081 (Illinois) | Primary |
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