NPIMap

Organization Active NPI

Garden of Prayer Youth Center

  • Early Intervention Provider Agency
  • Kankakee, IL
National Provider Identifier
1568867299
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
442707 Issued in IL
Legal business name
GARDEN OF PRAYER YOUTH CENTER
Practice address
381 S 4TH Ave
Kankakee, IL 60901-3607
Phone
(815) 401-5671
Fax
(815) 401-5726
NPI assigned
Oct 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

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

Authorized official

Name
Michael Maloney, LCPC
Title
Executive Director
Phone
(815) 933-2493

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 442707 IL Primary

Addresses

Primary practice location

381 S 4TH Ave
Kankakee, IL 60901-3607

Mailing address

657 E Court St
Suite 200
Kankakee, IL 60901-4055
Phone (815) 933-2493

Other names 1

  • Garden of Prayer Early Education & Intervention Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Garden of Prayer Youth Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

381 S 4th Ave
Kankakee, IL 60901
Phone (815) 401-5671

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414022400000",
    "number": "1568867299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "657 E COURT ST",
            "address_2": "SUITE 200",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609014055",
            "telephone_number": "815-933-2493",
            "fax_number": "815-933-2494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 S 4TH AVE",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013607",
            "telephone_number": "815-401-5671",
            "fax_number": "815-401-5726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDEN OF PRAYER YOUTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-23",
        "last_updated": "2014-10-23",
        "status": "A",
        "authorized_official_last_name": "MALONEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-933-2493",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IL",
            "license": "442707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Garden of Prayer Early Education & Intervention Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kankakee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; 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.