NPI 1891991550

Grand Victorian of Rockford, LLC

Organisation Point of Service Rockford, IL

Practice location

Address: 3495 McFarland Rd, Rockford, IL 61114-5609
Phone: (815) 654-1400
Fax: (815) 654-1488
Mailing address: 78 Centennial Loop, Eugene, OR 97401-7900

Authorised official

Name: John Holtz
Title: Controller
Phone: (541) 747-3373

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X

Other Point of Service providers in Illinois →

Registry record

NPI: 1891991550
Entity type: Organization
NPI issued: 21 Jun 2007
Record last updated: 13 May 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.