Organization · Type 2 NPI

Crusaders Central Clinic Association

Federally Qualified Health Center (FQHC) · Loves Park, IL

NPI number 1891082194 Active

Practice location

6115 N 2nd St
Loves Park, IL 61111-4155

Fax (815) 490-1625

Specialties and licenses

Taxonomy	Code	License
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed

Federally Qualified Health Center (FQHC): Definition to come...

2 other providers at this address

Laboratory Corporation of AmericaClinical Medical Laboratory Loves Park, IL NPI 1457904880
Matt HahnMental Health Counselor Loves Park, IL NPI 1447014493

NPI record

NPI: 1891082194
Entity type: Organization (Type 2)
Issued: Jul 7, 2011
Last updated: Aug 24, 2022
Status: Active
Subpart: Yes of Crusader Central Clinic Association

Other names

<unavail>
Crusader Community Health · doing business as
Crusader Community Health · doing business as

Authorized official

Mr. Samuel Miller
President and CEO
(815) 490-1737

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1891082194

Crusaders Central Clinic Association's National Provider Identifier is 1891082194, issued on Jul 7, 2011. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Loves Park, IL. The record was last updated on Aug 24, 2022.