GARDEN OF PRAYER YOUTH CENTER (NPI# 1427302413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427302413 |
| Entity Type | Organization |
| Organization Name | GARDEN OF PRAYER YOUTH CENTER |
| Practice Address |
16424 East State Route 114 Momence IL 60954 |
| Mailing Address |
657 E Court St Kankakee IL 60901-4055 |
| Practice Telephone | 8154722490 |
| Mailing Telephone | 8159332493 |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-10-30 |
| Authorized Official Name | MR. MICHAEL MALONEY (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8159332493 |
| Authorized Official Credential | MBA, LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 041-129-294 | IL | Agencies |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568867299 | Garden of Prayer Youth Center | Early Intervention Provider Agency | 381 S 4th Ave, Kankakee, IL 60901-3607 | 2014-10-23 |
| 1184028342 | Garden of Prayer Youth Center | Case Management | 1432 S 4th Ave, Kankakee, IL 60901-4931 | 2014-10-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | GARDEN OF PRAYER YOUTH CENTER, INCORPORATED | 657 E Court St Ste 200, Kankakee, IL 60901-4071 |
| Street Address |
16424 EAST STATE ROUTE 114 |
| City | MOMENCE |
| State | IL |
| Zip Code | 60954 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194373001 | Zoe Luedtke | Technician | 11841 E. Gregg Blvd., Momence, IL 60954 | 2019-09-04 |
| 1285096768 | Stacy Blider | Occupational Therapy Assistant | 932 Louise Dr, Momence, IL 60954 | 2016-03-24 |
| 1235376161 | Doc's Drugs Ltc | Skilled Nursing Facility | 2764 North Route 1-17, B, Momence, IL 60954 | 2009-01-14 |
| 1477741452 | Exceptional Health Partners S.c. | Family Medicine | 13043 S.e. 2260 Rd, Momence, IL 60954 | 2007-10-04 |
| 1790800597 | Momence Community Unit School District #1 | Local Education Agency (LEA) | 415 N Dixie Highway, Momence, IL 60954 | 2007-03-20 |
| 1063598068 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 2764 N. Route 1-17, Momence, IL 60954 | 2006-10-31 |
| 1689998700 | Good Shepherd Manor Groups Homes, Inc | Intermediate Care Facility, Mentally Retarded | 4129 N State Routes 1 & 17, Momence, IL 60954 | 2010-03-18 |
| 1750659199 | Good Shepherd Manor Inc | Intermediate Care Facility, Mentally Retarded | 4003 N. Routes 1 & 17, Momence, IL 60954-0260 | 2011-12-13 |
| 1841568284 | Good Shepherd Manor Inc | Intermediate Care Facility, Mentally Retarded | 4129a N. State Routes 1 & 17, Momence, IL 60954-0260 | 2011-12-13 |
| 1700100971 | Good Shepherd Manor, Inc | Custodial Care Facility | 4129 N State Routes 1 & 17, Momence, IL 60954-0260 | 2010-03-17 |
| Find all providers in zip 60954 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820648 | Community Wellness Group | Community/Behavioral Health | 635 Argyle Ave, Flossmoor, IL 60422-1201 | 2020-10-26 |
| 1437758711 | Gina Baldacci, Lcsw, LLC | Community/Behavioral Health | 231 Longridge Dr, Bloomingdale, IL 60108 | 2020-10-19 |
| 1790383610 | Joni Lamb Therapy, LLC | Community/Behavioral Health | 1555 Sherman Ave # 308, Evanston, IL 60201-4421 | 2020-10-13 |
| 1811594906 | Everyday Empowered Clinical Services, Ltd. | Community/Behavioral Health | 5117 Main St, Suite #7, Downers Grove, IL 60515 | 2020-10-02 |
| 1942817150 | Pacem Wellness, LLC | Community/Behavioral Health | 8 Eagle Ctr Ste 12, O Fallon, IL 62269-1947 | 2020-09-30 |
| 1831703271 | Boules Clinical Psychology Group | Community/Behavioral Health | 200 S Frontage Rd Ste 324, Burr Ridge, IL 60527-6953 | 2020-09-02 |
| 1336753896 | Counseling Kennedy Shenberg | Community/Behavioral Health | 5752 N Campbell Ave Apt 1, Chicago, IL 60659-5080 | 2020-09-02 |
| 1265045371 | Brightside Recovery | Community/Behavioral Health | 1667 Belvidere Rd, Belvidere, IL 61008-9306 | 2020-08-28 |
| 1902419021 | Brightside Recovery | Community/Behavioral Health | 8041 186th St Ste B, Tinley Park, IL 60487-9344 | 2020-08-28 |
| 1700498573 | Bobby E. Wright Comprehensive Behavioral Health Center, Inc. | Community/Behavioral Health | 5816 W Division St Fl 1, Chicago, IL 60651-1003 | 2020-08-21 |
| Find all providers with the same taxonomy | ||||
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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.