NPIMap

Organization Active NPI

Good Shepherd Center

  • Developmental Disabilities Clinic/Center
  • Hazel Crest, IL
National Provider Identifier
1093877045
Registry record updated Dec 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
License
008118 Issued in IL
Legal business name
GOOD SHEPHERD CENTER
Practice address
17314 Kedzie Ave
Hazel Crest, IL 60429-1619
Phone
(708) 335-0020
Fax
(708) 335-0022
NPI assigned
Dec 15, 2006
Last updated
Dec 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brendan P McCormick
Title
Executive Director
Phone
(708) 335-0020

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Developmental Disabilities Clinic/Center 261QD1600X 008118 IL Primary
Rehabilitation Clinic/Center 261QR0400X 008118 IL

Addresses

Primary practice location

17314 Kedzie Ave
Hazel Crest, IL 60429-1619

Mailing address

17314 Kedzie Ave
Hazel Crest, IL 60429-1619
Phone (708) 335-0020

National Provider Directory

National Provider Directory
Tax ID family
Good Shepherd Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

17314 Kedzie Ave
Hazel Crest, IL 60429
Phone (708) 335-0020

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449014400000",
    "number": "1093877045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17314 KEDZIE AVE",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604291619",
            "telephone_number": "708-335-0020",
            "fax_number": "708-335-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17314 KEDZIE AVE",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604291619",
            "telephone_number": "708-335-0020",
            "fax_number": "708-335-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2015-12-02",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "BRENDAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "708-335-0020",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "IL",
            "license": "008118",
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "IL",
            "license": "008118",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazel Crest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.