Organization
GOOD SHEPHERD CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENDAN P MCCORMICK (EXECUTIVE DIRECTOR)
(708) 335-0020
Entity
Organization
Contact information
Practice address
17314 KEDZIE AVE, HAZEL CREST, IL 60429-1619
(708) 335-0020
(708) 335-0022
Mailing address
17314 KEDZIE AVE, HAZEL CREST, IL 60429-1619
(708) 335-0020
(708) 335-0022
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
008118
IL
261QR0400X
Rehabilitation Clinic/Center
008118
IL
Other
Enumeration date
12/15/2006
Last updated
12/02/2015
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