| Crusader Community Health | |
|
6115 N 2nd St Loves Park IL 61111-4155 | |
| (815) 490-1600 | |
| (815) 490-1625 |
| Full Name | Crusader Community Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 6115 N 2nd St, Loves Park, Illinois |
| Authorized Official Name and Position | Samuel Miller (PRESIDENT AND CEO) |
| Authorized Official Contact | 8154901737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crusader Community Health 6115 N 2nd St Loves Park IL 61111-4155 Ph: (815) 490-1600 | Crusader Community Health 6115 N 2nd St Loves Park IL 61111-4155 Ph: (815) 490-1600 |
| NPI Number | 1891082194 |
|---|---|
| Provider Enumeration Date | 07/07/2011 |
| Last Update Date | 08/24/2022 |
| Medicare PECOS PAC ID | 5799682993 |
|---|---|
| Medicare Enrollment ID | O20110909002867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891082194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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