NPIMap

Organization Active NPI

Family Christian Health Center

  • Federally Qualified Health Center (FQHC)
  • Harvey, IL
National Provider Identifier
1487240016
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY CHRISTIAN HEALTH CENTER
Doing business as
Family Christian Health Center
Practice address
15620 Wood St
Harvey, IL 60426-4171
Phone
(708) 596-5177
NPI assigned
Dec 17, 2020
Last updated
Jul 16, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY CHRISTIAN HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Authorized official

Name
Jacqueline Y Donaldson
Title
Credentialing
Phone
(708) 596-5177

Specialties & licenses 1

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

Addresses

Primary practice location

15620 Wood St
Harvey, IL 60426-4171

Mailing address

31 W 155TH St
Harvey, IL 60426-3556
Phone (708) 596-5177

Other names 1

  • FAMILY CHRISTIAN HEALTH CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040325000572 IL Part B Supplier - Clinic/Group Practice 6507758612 Receives reassigned benefits from 43 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Harvey, IL; Lynwood, IL; Dolton, IL
O20210211002458 IL Part A Provider - Federally Qualified Health Center (FQHC) 6507758612 Practice locations: Harvey, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487240016. Details of each certification follow.

Federally qualified health center certification: CCN 781948

Legal name
FAMILY CHRISTIAN HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 11, 2021
Last certification
Feb 11, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 2020 in IL
Enrollment address
15620 Wood St
Harvey, IL 60426-4171

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Family Christian Health Center7 organizations share this tax ID, including this one
Part of
Family Christian Health Center

Other organizations with this tax ID 6

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

Locations

31 W 155th St
Ste F
Harvey, IL 60426

19767 Torrence Ave
Lynwood, IL 60411
Phone (708) 596-5177

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Vernice Davis-Clark Individual Corporate OfficerBoard Member Jan 1, 2013
Deane Taylor Individual Corporate OfficerBoard Member Jan 1, 2024
Karen Jacobs Individual Corporate OfficerBoard President Jan 1, 2013
Lisa J Green Individual Corporate DirectorCeo Apr 1, 2010 100%
Operational/Managerial Control Oct 1, 2018 100%
Kimberly Jones-Saunders Individual Corporate OfficerMember Jan 1, 2013
Kenneth McGhee Individual Corporate OfficerBoard Member Jan 1, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Lisa J Green
    • Family Medicine Physician
    • Harvey, IL
    • NPI 1114973062

    Corporate Director, Operational/Managerial Control

    CMS ownership

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": "1608163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1487240016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177",
            "fax_number": "708-596-5518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15620 WOOD ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604264171",
            "telephone_number": "708-596-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CHRISTIAN HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY CHRISTIAN HEALTH CENTER",
        "enumeration_date": "2020-12-17",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "708-596-5177"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY CHRISTIAN HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harvey, IL

Sources for this page

Verify at the official NPI Registry.