Provider Demographics
NPI:1699866681
Name:ROCK VALLEY WOMEN'S HEALTH CENTER, LLC
Entity type:Organization
Organization Name:ROCK VALLEY WOMEN'S HEALTH CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-637-6200
Mailing Address - Street 1:6861 VILLAGREEN VW
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5639
Mailing Address - Country:US
Mailing Address - Phone:815-637-6200
Mailing Address - Fax:815-637-1998
Practice Address - Street 1:6861 VILLAGREEN VW
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5639
Practice Address - Country:US
Practice Address - Phone:815-637-6200
Practice Address - Fax:815-637-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0030559-6174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL0100OtherJOHN DEERE
IL10123243OtherBLUE CROSS BLUE SHIELD
IL10123243OtherBLUE CROSS BLUE SHIELD