| Rosecrance Inc | |
|
1112 Lincolnshire Dr Champaign IL 61821 | |
| (815) 391-1000 | |
| (815) 316-4726 |
| Full Name | Rosecrance Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1112 Lincolnshire Dr, Champaign, Illinois |
| Authorized Official Name and Position | Phil Eaton (CEO / PRESIDENT) |
| Authorized Official Contact | 8153911000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rosecrance Inc 1021 N Mulford Rd Rockford IL 61107-3877 Ph: (815) 391-1000 | Rosecrance Inc 1112 Lincolnshire Dr Champaign IL 61821 Ph: (815) 391-1000 |
| NPI Number | 1083061469 |
|---|---|
| Provider Enumeration Date | 05/16/2016 |
| Last Update Date | 09/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083061469 | NPI | - | NPPES |
| 04081 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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