Healthcare Provider Details

I. General information

NPI: 1871533828
Provider Name (Legal Business Name): CGH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 E LYNN BLVD SUITE B
STERLING IL
61081-1717
US

IV. Provider business mailing address

3010 E LYNN BLVD SUITE B
STERLING IL
61081
US

V. Phone/Fax

Practice location:
  • Phone: 815-622-0836
  • Fax:
Mailing address:
  • Phone: 815-622-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1006451
License Number StateIL

VIII. Authorized Official

Name: MS. DENISE WOODEN
Title or Position: DIRECTOR CGH HOME NURSING
Credential: RN
Phone: 815-622-0836