CRUSADERS CENTRAL CLINIC ASSOCIATION (NPI# 1891082194) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891082194 |
| Entity Type | Organization |
| Organization Name | CRUSADERS CENTRAL CLINIC ASSOCIATION |
| Other Organization Name | CRUSADER COMMUNITY HEALTH LOVES PARK |
| Practice Address |
6115 N 2nd St Loves Park IL 61111-4155 |
| Mailing Address |
1200 W State St Rockford IL 61102-2112 |
| Practice Telephone | 8154901600 |
| Practice Fax Number | 8154901625 |
| Mailing Telephone | 8154901600 |
| Mailing Fax Number | 8154901845 |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2019-03-19 |
| Authorized Official Name | MR. GORDON EGGERS (PRESIDENT AND CEO) |
| Authorized Official Telephone | 8154901600 |
| Is Organization Subpart | Y |
| Parent Organization Name | CRUSADER CENTRAL CLINIC ASSOCIATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Crusader Community Health Loves Park | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205238623 | Crusaders Central Clinic Association | Clinic/Center | 1002 N Pierpont Ave, Rockford, IL 61101 | 2014-09-17 |
| 1780852244 | Crusaders Central Clinic Association | Clinic/Center | 1050 Logan Ave, Belvidere, IL 61008-3966 | 2008-02-18 |
| 1164999892 | Crusaders Central Clinic Association | Case Management | 1200 W State St, Rockford, IL 61102-2112 | 2018-10-31 |
| 1346762390 | Crusaders Central Clinic Association | Clinic/Center | 840 Blackhawk Blvd, South Beloit, IL 61080-2263 | 2017-07-12 |
| 1811419245 | Crusaders Central Clinic Association | Clinic/Center | 245 Prairie Hill Rd, South Beloit, IL 61080-2579 | 2017-07-07 |
| 1508306861 | Crusaders Central Clinic Association | Clinic/Center | 1215 N Alpine Rd, Rockford, IL 61107-2201 | 2017-03-06 |
| 1922358373 | Crusaders Central Clinic Association | Clinic/Center | 2704 N Main St, Rockford, IL 61103-3112 | 2012-09-13 |
| 1417203191 | Crusaders Central Clinic Association | Clinic/Center | 1200 W State St, Rockford, IL 61102-2112 | 2012-07-31 |
| 1265601488 | Crusaders Central Clinic Association | Clinic/Center | 1100 Broadway, Rockford, IL 61104-1429 | 2008-02-21 |
| 1073782298 | Crusaders Central Clinic Association | Clinic/Center | 1200 W State St, Rockford, IL 61102-2112 | 2008-02-21 |
| Street Address |
6115 N 2ND ST |
| City | LOVES PARK |
| State | IL |
| Zip Code | 61111-4155 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457904880 | Laboratory Corporation of America | Clinical Medical Laboratory | 6115 N 2nd St, Loves Park, IL 61111-4155 | 2019-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316562788 | Salli Jacobsen | Technician | 6699 Torch Lite Tr, Loves Park, IL 61111 | 2020-06-11 |
| 1003476425 | Costco Wholesale Corporation | Pharmacy | 5000 Stadium Drive, Loves Park, IL 61111 | 2019-06-18 |
| 1427541077 | Ronit Golan | Physical Therapist | 4401 Peak Dr Ste 1, Loves Park, IL 61111 | 2018-06-08 |
| 1598049025 | Sara Debelak | Developmental Therapist | 7225 Golden Eagle Drive, Loves Park, IL 61111 | 2011-10-03 |
| 1083906382 | Gagandeep Goyal | Anesthesiology | 5504 N 2nd St, Loves Park, IL 61111 | 2011-05-05 |
| 1124354261 | Asap Transport, LLC | Taxi | 7117 Clinton Rd, Suite 4, Loves Park, IL 61111 | 2009-10-25 |
| 1235212275 | Roger H Hill | Optometrist | 4301 N Mulford Rd, Loves Park, IL 61111 | 2006-10-23 |
| 1831104546 | Pointcore, Inc. | Pharmacy | 9951 Rock Cut Crossing, Loves Park, IL 61111 | 2006-07-30 |
| 1629099627 | Lisa A. Breisch | Counselor | Harmony Center for Holistic Psychotherapy, 6625 N. 2nd Street, Loves Park, IL 61111 | 2006-07-22 |
| 1386670529 | Joseph L Digirolamo | Chiropractor | 116 East Riverside Blvd, Loves Park, IL 61111 | 2006-06-22 |
| Find all providers in zip 61111 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417567108 | Pillars Community Health | Clinic/Center | 15w458 91st St, Burr Ridge, IL 60527-6379 | 2020-08-06 |
| 1932724390 | Friend Family Health Center, Inc | Clinic/Center | 7355 S Jeffery Blvd, Chicago, IL 60649-3121 | 2020-06-11 |
| 1871117937 | Primecare Community Health Inc | Clinic/Center | 1431 N Western Ave Ste 101, Chicago, IL 60622-7712 | 2020-06-04 |
| 1639791569 | Community Health Partnership of Illinois | Clinic/Center | 201 W Kenyon Rd Bldg D, Champaign, IL 61820-7892 | 2020-05-14 |
| 1407482219 | Access Community Health Network | Clinic/Center | 6020 W Diversey Ave Bldg West, Chicago, IL 60639-1108 | 2020-03-13 |
| 1235769704 | Greater Elgin Family Care Center | Clinic/Center | 451 N Mclean Blvd, Elgin, IL 60123-3239 | 2020-01-23 |
| 1710517537 | Greater Elgin Family Care Center Integrated Health Home | Clinic/Center | 1100 Shirley Ave, Streamwood, IL 60107-3068 | 2020-01-21 |
| 1215578109 | Board of Trustees of Southern Illinois University | Clinic/Center | 205 S 24th St Ste 100, Quincy, IL 62301-4446 | 2019-10-02 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1427600345 | The Board of Trustees of The University of Illinois | Clinic/Center | 6835 S Normal Blvd, Chicago, IL 60621-2535 | 2019-07-11 |
| Find all providers with the same taxonomy | ||||
| City | LOVES PARK |
| Zip Code | 61111 |
Please comment or provide details below to improve the information on CRUSADERS CENTRAL CLINIC ASSOCIATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.