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General NPI Number Information
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NPI Number | 1952258469
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Entity Type | Organization
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Legal Business Name | CRUSADERS CENTRAL CLINIC ASSOCIATION
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 4592 LINDEN ROAD
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City | ROCKFORD
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State | IL
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Zip | 61109
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Country | US
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Telephone | 815-490-1600
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Fax | 815-490-1881
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Provider Business Mailing Address
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Address Line | 4592 LINDEN ROAD
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City | ROCKFORD
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State | IL
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Zip | 61109
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Country | US
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Telephone | 815-490-1600
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Fax | 815-490-1881
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Authorized Official
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Title or Position | CREDENTIALING ADMINISTRATOR
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Name | PEGGYANNE DAVENPORT
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Credential |
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Telephone | 815-490-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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