Healthcare Provider Details

I. General information

NPI: 1083592604
Provider Name (Legal Business Name): CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 S WATER TOWER PL STE D
MOUNT VERNON IL
62864-6567
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-242-4848
  • Fax:
Mailing address:
  • Phone: 618-724-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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