Healthcare Provider Details

I. General information

NPI: 1053252668
Provider Name (Legal Business Name): WILL GRUNDY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 E CASS ST
JOLIET IL
60432-2812
US

IV. Provider business mailing address

213 E CASS ST
JOLIET IL
60432-2812
US

V. Phone/Fax

Practice location:
  • Phone: 815-726-3377
  • Fax: 815-726-3377
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LASHAWN WEST
Title or Position: CEO
Credential:
Phone: 815-726-3377