GOOD SHEPHERD CENTER (NPI# 1093877045) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093877045 |
| Entity Type | Organization |
| Organization Name | GOOD SHEPHERD CENTER |
| Practice Address |
17314 Kedzie Ave Hazel Crest IL 60429-1619 |
| Practice Telephone | 7083350020 |
| Practice Fax Number | 7083350022 |
| Mailing Telephone | 7083350020 |
| Mailing Fax Number | 7083350022 |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2015-12-02 |
| Authorized Official Name | MR. BRENDAN P MCCORMICK (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7083350020 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251B00000X | Case Management | Agencies | ||
| N | 261QR0400X |
Clinic/Center Specialization: Rehabilitation |
008118 | IL | Ambulatory Health Care Facilities |
| Y | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
008118 | IL | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295999340 | Good Shepherd Center | Early Intervention Provider Agency | 529 Cottonwood Rd, Frankfort, IL 60423-1009 | 2008-07-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | GOOD SHEPHERD CENTER FOR EXCEPTIONAL CHILDREN | 17314 Kedzie Ave, Hazel Crest, IL 60429-1619 |
| Street Address |
17314 KEDZIE AVE |
| City | HAZEL CREST |
| State | IL |
| Zip Code | 60429-1619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659917987 | Nancy Sinwelski | Technician | 17305 Fisk Street, East Hazelcrest, IL 60429 | 2019-11-21 |
| 1144720871 | Plentiful Hair Studio LLC | Specialist | 17504 E Carriageway Dr Ste D, Hazel Crest, IL 60429 | 2018-02-19 |
| 1376052142 | Natalie Allen | Counselor | 3518 Birchwood Dr, Hazel Crest, IL 60429 | 2017-09-25 |
| 1730534009 | Lydena Franklin | Counselor | 1909 Cheker Square, East Hazel Crest, IL 60429 | 2016-04-25 |
| 1710331053 | Lauiren Orta | Counselor | 1901 Cheker Square, E Hazel Crest, IL 60429 | 2016-04-22 |
| 1427423367 | Andrea Leigh Warren | Nurse Practitioner | 17800 S. Kedzie Ave, Hazel Crest, IL 60429 | 2015-12-03 |
| 1770969354 | Karriem's Developmental Services | Day Training, Developmentally Disabled Services | 18513 River Road, Hazel Crest, IL 60429 | 2015-08-05 |
| 1073905170 | James Kamper | Physical Therapy Assistant | 1816 W 170th Street, Hazel Crest, IL 60429 | 2015-02-26 |
| 1194066019 | Marilyn C Scott | Psychologist | 18505 Meadow Ln., Hazel Crest, IL 60429 | 2013-03-04 |
| 1649548405 | Supported Independence | Community/Behavioral Health | 17009 Elm Drive, Hazel Crest, IL 60429 | 2011-12-08 |
| Find all providers in zip 60429 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
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| 1689225237 | Rebecca Lynn Madden | Clinic/Center | 6331 Vv Rd, Prairie Du Rocher, IL 62277-1411 | 2019-09-25 |
| 1699238170 | Soreida Mamie Fennerr | Clinic/Center | 7729 S Loomis Blvd, Chicago, IL 60620-3751 | 2019-04-10 |
| 1710432968 | Alvin Eades Center Inc | Clinic/Center | 905 W Superior Ave, Jacksonville, IL 62650-3117 | 2016-08-17 |
| 1740649193 | Smile More Dental 3 Corp | Clinic/Center | 1480 N Orchard Rd, #104, Aurora, IL 60506-7939 | 2016-02-14 |
| 1356778823 | Dia Corporate of Illinois, Inc | Clinic/Center | 1601 Broadway Ave, Mattoon, IL 61938-4096 | 2013-09-30 |
| 1689988248 | Flying High Gymnastics, Inc | Clinic/Center | 5400 East Ave, Countryside, IL 60525-3112 | 2010-08-05 |
| 1730366154 | Move N & Cruise N Kidz LLC | Clinic/Center | 1211 Deerfield Pkwy, Apt 101, Buffalo Grove, IL 60089-4563 | 2008-01-28 |
| 1821215062 | The Arc of Iroquois County | Clinic/Center | 700 E Elm St, Watseka, IL 60970-1400 | 2007-04-19 |
| 1992708960 | Easter Seals Joliet Region Inc. | Clinic/Center | 212 Barney Dr, Joliet, IL 60435-5271 | 2005-05-24 |
| Find all providers with the same taxonomy | ||||
| City | HAZEL CREST |
| Zip Code | 60429 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.