Organization
CRUSADERS CENTRAL CLINIC ASSOCIATION
Active
Organization
CRUSADERS CENTRAL CLINIC ASSOCIATION
Active
Parent organization
CRUSADER CENTRAL CLINIC ASSOCIATION
Other names
Crusader Community Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
CRUSADER CENTRAL CLINIC ASSOCIATION
Authorized official
MR. SAMUEL MILLER (PRESIDENT AND CEO)
(815) 490-1737
Entity
Organization
Contact information
Practice address
6115 N 2ND ST, LOVES PARK, IL 61111-4155
(815) 490-1600
(815) 490-1625
Mailing address
6115 N 2ND ST, LOVES PARK, IL 61111-4155
(815) 490-1600
(815) 490-1845
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
07/07/2011
Last updated
08/24/2022
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