| Rosecrance Ware Center | |
|
2704 N Main St Rockford IL 61103 | |
| (815) 391-1000 | |
| (815) 316-4726 |
| Full Name | Rosecrance Ware Center |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2704 N Main St, Rockford, Illinois |
| Authorized Official Name and Position | Philip Eaton (CEO / PRESIDENT) |
| Authorized Official Contact | 8153911000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rosecrance Ware Center 1021 N Mulford Rd Rockford IL 61107-3877 Ph: (815) 391-1000 | Rosecrance Ware Center 2704 N Main St Rockford IL 61103 Ph: (815) 391-1000 |
| NPI Number | 1346656923 |
|---|---|
| Provider Enumeration Date | 07/03/2014 |
| Last Update Date | 09/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346656923 | NPI | - | NPPES |
| 04081 | Medicaid | IL | |
| A-0601-0044-A | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 40108 (Illinois) | Primary |
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