NPIMap

Organization Active NPI

Grand Prairie Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Matteson, IL
National Provider Identifier
1639233174
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
GRAND PRAIRIE SERVICES
Practice address
21136 Keeler Ave
Matteson, IL 60443-2242
Phone
(708) 481-1360
Fax
(708) 481-9442
NPI assigned
Dec 20, 2006
Last updated
Nov 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

21136 Keeler Ave
Matteson, IL 60443-2242

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

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…

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Grand Prairie Services21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1639233174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17746 OAK PARK AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604773936",
            "telephone_number": "708-444-1012",
            "fax_number": "708-614-9449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21136 KEELER AVE",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432242",
            "telephone_number": "708-481-1360",
            "fax_number": "708-481-9442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND PRAIRIE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "SHARRONNE",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "708-444-1012"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matteson, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.