Healthcare Provider Details

I. General information

NPI: 1720146319
Provider Name (Legal Business Name): CRESCENT COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 ELM ST STE 300
DUBUQUE IA
52001-3679
US

IV. Provider business mailing address

1690 ELM ST STE 300
DUBUQUE IA
52001-3679
US

V. Phone/Fax

Practice location:
  • Phone: 563-690-0321
  • Fax: 563-557-8488
Mailing address:
  • Phone: 563-690-2850
  • Fax: 563-239-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number08349
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA100692
License Number StateIA

VIII. Authorized Official

Name: CHAD WOLBERS
Title or Position: CEO
Credential:
Phone: 563-690-2862