Crusaders Central Clinic Association
Clinic/Center, Federally Qualified Health Center (FQHC) in Rockford, IL. Organization (NPI-2).
NPI number1265601488
StatusActive
Last updated in NPPESAug 24, 2022
Details
- NPI
- 1265601488
- Entity type
- Organization (NPI-2)
- Legal business name
- Crusaders Central Clinic Association
- Organization subpart
- Yes
- Enumeration date
- Feb 21, 2008
- Certification date
- Aug 24, 2022
- Last updated
- Aug 24, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | – | – | Yes |
Other names
- Crusader Clinic Broadway (Doing Business As)
Practice location
1100 BroadwayRockford, IL 61104-1429
Phone 815-490-1601 · Fax 815-490-1625
Mailing address
1100 BroadwayRockford, IL 61104-1429
Phone 815-490-1600 · Fax 815-490-1845
Authorized official
Samuel Miller
President & Ceo
8154901737
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All 9 Federally Qualified Health Center (FQHC) providers in Rockford · All 5,035 providers in Rockford
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