| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 910 2nd Ave, Rockford, Illinois |
| Authorized Official Name and Position | Christina Nicole Hobson (AUTHORIZED OFFICIAL, HUMAN RESOURCE) |
| Authorized Official Contact | 2708396743 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
910 2nd Ave Rockford IL 61104-2162 Ph: (270) 839-6743 | 910 2nd Ave Rockford IL 61104-2162 Ph: (270) 839-6743 |
| NPI Number | 1093307266 |
|---|---|
| Provider Enumeration Date | 02/09/2021 |
| Last Update Date | 11/03/2022 |
| Certification Date | 11/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093307266 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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