CRUSADERS CENTRAL CLINIC ASSOCIATION (NPI# 1922358373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922358373 |
| Entity Type | Organization |
| Organization Name | CRUSADERS CENTRAL CLINIC ASSOCIATION |
| Other Organization Name | ROSECRANCE WARE CENTER |
| Practice Address |
2704 N Main St Rockford IL 61103-3112 |
| Mailing Address |
1200 W State St Rockford IL 61102-2112 |
| Practice Telephone | 8154901600 |
| Practice Fax Number | 8154901845 |
| Mailing Telephone | 8154901600 |
| Mailing Fax Number | 8154901845 |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2019-03-19 |
| Authorized Official Name | MR. GORDON EGGERS (CEO/PRESIDENT) |
| Authorized Official Telephone | 8154901600 |
| Authorized Official Credential | PA |
| Is Organization Subpart | Y |
| Parent Organization Name | CRUSADERS CENTRAL CLINIC ASSOCIATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Rosecrance Ware Center | 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 |
| 1891082194 | Crusaders Central Clinic Association | Clinic/Center | 6115 N 2nd St, Loves Park, IL 61111-4155 | 2011-07-07 |
| 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 |
| 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 |
2704 N MAIN ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61103-3112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689209736 | Kristie L Miller | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2020-03-10 |
| 1033763446 | Linda Haugen | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2019-07-25 |
| 1790240935 | Jamie Motos | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2019-02-01 |
| 1780153064 | Kaitlyn Folliard | Social Worker | 2704 N Main St, Rockford, IL 61103-3112 | 2018-11-16 |
| 1871077354 | Brittany Torres | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-20 |
| 1447734256 | Careena Whisper-marie Barker | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-18 |
| 1255814620 | Kevin Smerko | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-12 |
| 1467935791 | Dana Harder | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-12 |
| 1396228631 | Nirandone Thammarath | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-12 |
| 1073095923 | Natalie Hanna | Counselor | 2704 N Main St, Rockford, IL 61103-3112 | 2018-09-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598398497 | The Elitist Group | Home Health Aide | 2929 N Main Street, Rockford, IL 61103 | 2020-02-19 |
| 1972064194 | Mahita Bellamkonda | Student in an Organized Health Care Education/Training Program | 2400 North Rockton Avenue, Rockford, IL 61103 | 2019-03-29 |
| 1558538967 | Willows Health Center | Clinic/Center | 4143 Albright Lane, Rockford, IL 61103 | 2008-05-14 |
| 1497845135 | Humaira Bari | Internal Medicine | 2400 N. Rockton Avenue, Rockford, IL 61103 | 2006-10-13 |
| 1841385242 | Rachel Pawlowski | Occupational Therapist | 3616 N. Main Street, Rockford, IL 61103 | 2006-10-03 |
| 1417068438 | Alicia Anne Huntley | Midwife | 2400 Rockton Ave, Rockford, IL 61103 | 2006-08-31 |
| 1639190200 | Glendon Burress | Pediatrics | 2300 N. Rockton Ave., Rockford Health Physicians, Rockford, IL 61103 | 2006-07-21 |
| 1225065204 | Daniel William Johnson | Dentist | 519 Toner Av, Rockford, IL 61103 | 2006-06-27 |
| 1760472898 | Ronald Peter Oberfoell | Anesthesiology | 2400 North Rockton Ave, Rockford Health Physicians, Rockford, IL 61103 | 2005-10-28 |
| 1841752532 | Dipti Sabharwal | Student in an Organized Health Care Education/Training Program | 2400 N Rockton Avenue, Rockford, IL 61103 | 2019-04-02 |
| Find all providers in zip 61103 | ||||
| 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 |
|---|---|---|---|---|
| 1205238623 | Crusaders Central Clinic Association | Clinic/Center | 1002 N Pierpont Ave, Rockford, IL 61101 | 2014-09-17 |
| 1306486022 | The Board of Trustees of The University of Illinois | Clinic/Center | 1221 E State St, Rockford, IL 61104-2231 | 2020-01-10 |
| 1295386308 | Altapointe Health Systems, Inc. | Clinic/Center | 9518 Us Highway 231, Rockford, AL 35136-5214 | 2019-09-20 |
| 1043746720 | Aunt Martha's Health and Wellness | Clinic/Center | 1401 E State St, Suite 3000, Rockford, IL 61104-2315 | 2017-05-02 |
| 1508306861 | Crusaders Central Clinic Association | Clinic/Center | 1215 N Alpine Rd, Rockford, IL 61107-2201 | 2017-03-06 |
| 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 |
| 1437328655 | Crusaders Central Clinic Association | Clinic/Center | 1720 18th Ave, Rockford, IL 61104-7352 | 2008-02-21 |
| 1902972557 | Crusaders Central Clinic Association | Clinic/Center | 1200 W State St, Rockford, IL 61102-2112 | 2006-11-27 |
| Find all providers in ROCKFORD | ||||
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| 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.