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NPI Code Detail

MEDICARE: GRAND PRAIRIE SERVICES

MEDICARE: GRAND PRAIRIE SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1063576502
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRAND PRAIRIE SERVICES
Provider Business Mailing Address
First Line : 17746 OAK PARK AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3936
Country : US
Telephone Number : 708-444-1012
Fax Number : 708-614-9449
Provider Business Practice Location Address
First Line : 67 E 34TH ST
Second Line :
City : STEGER
State : IL
Zip : 60475-1106
Country : US
Telephone Number : 708-756-0010
Fax Number :
Authorized Official
Title or Position : PRESIDENT & CEO
Name : SHARRONNE WARD
Credential :
Telephone Number : 708-444-1012
Provider Enumeration Date : 12/20/2006
Last Update Date : 11/20/2023

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Directions to “GRAND PRAIRIE SERVICES ” Practice Location

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