| Rosecrance Benton Supervised Living | |
|
1509 Benton St Rockford IL 61107-4322 | |
| (815) 391-1000 | |
| Not Available |
| Full Name | Rosecrance Benton Supervised Living |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1509 Benton St, 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 Benton Supervised Living 1021 N Mulford Rd Rockford IL 61107-3877 Ph: (815) 391-1000 | Rosecrance Benton Supervised Living 1509 Benton St Rockford IL 61107-4322 Ph: (815) 391-1000 |
| NPI Number | 1710268008 |
|---|---|
| Provider Enumeration Date | 08/31/2011 |
| Last Update Date | 12/08/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710268008 | NPI | - | NPPES |
| 04081 | Medicaid | IL |
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