Grand Prairie Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

5102790 Issued in IL

Legal business name

GRAND PRAIRIE ASSISTED LIVING

Practice address

1307 Meadowlark LN
Macomb, IL 61455-7508

Phone

(309) 833-5000

Fax

(309) 833-6410

NPI assigned

Apr 18, 2013

Last updated

Apr 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jack Laverdiere

Title

Owner

Phone

(309) 837-1258

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1366243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366243200000",
    "number": "1902240187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 MEADOWLARK LN",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614557508",
            "telephone_number": "309-833-5000",
            "fax_number": "309-833-6410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 MEADOWLARK LN",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614557508",
            "telephone_number": "309-833-5000",
            "fax_number": "309-833-6410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND PRAIRIE ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-18",
        "last_updated": "2013-04-18",
        "status": "A",
        "authorized_official_last_name": "LAVERDIERE",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-837-1258"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": "5102790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Joseph Gonzales, MD
• Tiffany Erin Gorsuch Bainter, PHD, LCPC, NCC
• Graham Hospital Association
• Graham Hospital Association (Graham Medical Group Macomb-Bushnell)
• Graham Hospital Association (Graham Medical Group Macomb)
• David J Greathouse, D.O.
• Jennifer Greer, BSN. RN
• Terri Marie Guilford, PSYD
• Cade Guthrie
• William Hall, DMD

• Assisted Living Facility in Macomb, IL
• Providers in Macomb, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; 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.