1013718303 NPI number — GREATER WORKS REINTEGRATION OUTREACH CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013718303 NPI number — GREATER WORKS REINTEGRATION OUTREACH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER WORKS REINTEGRATION OUTREACH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013718303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18247 CORK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TINLEY PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60477-4709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-837-1962
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4747 LINCOLN MALL DR STE 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATTESON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60443-3821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-499-6197
Provider Business Practice Location Address Fax Number:
630-423-7873
Provider Enumeration Date:
03/21/2025

Additional Information

Authorized Official

Authorized Official Last Name:
BASS
Authorized Official First Name:
ETHEL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
630-499-6197

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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