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Grand Prairie Services

Organization Active NPI Federally Qualified Health Center (FQHC) · Chicago Heights, IL

NPI 1447723564 · NPPES record last updated Nov 20, 2023

Key facts

NPI
1447723564
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
GRAND PRAIRIE SERVICES
Practice address
450 W 14TH St
Chicago Heights, IL 60411-2463
Phone
(708) 985-3040
Fax
(708) 474-8144
NPI assigned
Jan 11, 2019
Organization subpart
Yes
Parent organization (as reported)
GRAND PRAIRIE SERVICES

Authorized official

Name
Sharronne Ward
Title
President and Ceo
Phone
(708) 444-1012

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 20

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

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 63

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IL

Federally qualified health center certification: CCN 781926

Legal name
GRAND PRAIRIE SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 18, 2019
Last certification
Jun 18, 2019
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
May 10, 1956 in IL
Enrollment address
450 W 14TH St
Chicago Heights, IL 60411-2463

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Deborah White
Individual 		Corporate Director Sep 1, 2016
Billie Williams
Individual 		Corporate Director Sep 1, 2016
Sharronne Ingrid Ward
Individual 		Corporate Director Oct 27, 2011 100%
Operational/Managerial Control Oct 27, 2011 100%
Howard Robinson
Individual 		Corporate Officer
Chairman Board of Directors		 Jan 1, 2019 100%
Susan Turner
Individual 		Corporate Director Sep 1, 2019

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20041116000208 IL Part B Supplier - Clinic/Group Practice 7517876691 Receives reassigned benefits from 8 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bradley, IL; Tinley Park, IL; Steger, IL; South Holland, IL; Park Forest, IL; Midlothian, IL; Matteson, IL; Flossmoor, IL…
O20190618000620 IL Part a Provider - Federally Qualified Health Center (FQHC) 7517876691 Practice locations: Chicago Heights, IL

National Provider Directory

Tax ID family
Grand Prairie Services (21 organizations share this tax ID)
Part of
Grand Prairie Services

Locations

1240 Ashland Ave
Chicago Heights, IL 60411
Phone (708) 755-2250

19530 Governors Hwy
Flossmoor, IL 60422
Phone (708) 799-2200

15406 Lexington Ave
Harvey, IL 60426
Phone (708) 596-5900

19400 N Creek Dr
Lynwood, IL 60411
Phone (708) 474-0410

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

450 W 14TH St
Chicago Heights, IL 60411-2463

Mailing address

17746 Oak Park Ave
Tinley Park, IL 60477-3936
Phone (708) 444-1012

Other providers in Chicago Heights, IL

All providers in Chicago Heights, IL · Federally Qualified Health Center (FQHC) in Illinois

Sources for this page

Verify at the official NPI Registry.