Healthcare Provider Details

I. General information

NPI: 1588391833
Provider Name (Legal Business Name): CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 STATE HIGHWAY 14
CHRISTOPHER IL
62822-1037
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-724-2401
  • Fax: 618-724-9257
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MITROKA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 618-724-2401