| Grand Prairie Services | |
|
19707 Terrace Ave Lynwood IL 60411-1335 | |
| (708) 895-8057 | |
| Not Available |
| Full Name | Grand Prairie Services |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 19707 Terrace Ave, Lynwood, Illinois |
| Authorized Official Name and Position | Dennis Regnier (PRESIDENT & CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7086231501 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Prairie Services 17746 Oak Park Ave Tinley Park IL 60477-3936 Ph: (708) 444-1012 | Grand Prairie Services 19707 Terrace Ave Lynwood IL 60411-1335 Ph: (708) 895-8057 |
| NPI Number | 1740344027 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 11/20/2023 |
| Certification Date | 11/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740344027 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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