OrganizationActive
Grand Victorian of Rockford, LLC
NPI 1891991550 · Point of Service · Rockford, IL
Provider details
- NPI number
- 1891991550
- Entity type
- Organization
- Primary specialty
- Point of ServiceManaged Care Organizations
- Organization subpart
- No
- Authorized official
- John Holtz, Controller(541) 747-3373
Specialties & taxonomies
Managed Care Organizations
Practice location
3495 Mcfarland Rd
Rockford, IL 61114-5609
Phone: (815) 654-1400
Fax: (815) 654-1488
Approximate (ZIP-level) locationGet directions
Mailing address
78 Centennial Loop
Eugene, OR 97401-7900
Registry dates
- Enumerated
- 2007-06-21
- Last updated
- 2008-05-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.