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General NPI Number Information
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NPI Number | 1184661514
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Entity Type | Organization
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Legal Business Name | CGH MEDICAL CENTER
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 3010 E. LYNN BLVD
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City | STERLING
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State | IL
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Zip | 61081
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Country | US
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Telephone | 815-622-0836
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Fax | 815-622-9456
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Provider Business Mailing Address
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Address Line | 3010 E. LYNN BLVD SUITE B
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City | STERLING
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State | IL
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Zip | 61081
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Country | US
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Telephone | 815-625-3476
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JUDY HENTGES
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Credential | RN, BSN
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Telephone | 815-622-0836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 093013381
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License Number State | IL
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