Healthcare Provider Details

I. General information

NPI: 1134024268
Provider Name (Legal Business Name): CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N LOGAN ST
WEST FRANKFORT IL
62896-2329
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-923-7201
  • Fax: 618-923-7202
Mailing address:
  • Phone: 618-724-1602
  • Fax: 855-634-9302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY MITROKA
Title or Position: CEO
Credential:
Phone: 618-724-1602