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GRAND PRAIRIE ASSISTED LIVING
NPI 1902240187
Assisted Living Facility in Macomb, IL

Active since April 18, 2013CLIA 14D2198208 · Waiver
1307 MEADOWLARK LN, MACOMB, IL 61455(309) 833-5000(309) 833-6410 Get Directions Write a Review

NPPES record last updated: April 18, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Grand Prairie Assisted Living NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAND PRAIRIE ASSISTED LIVING (NPI 1902240187) is a healthcare organization registered as an assisted living facility in Macomb, Illinois and active in the NPI registry since April 2013. The organization holds a CLIA Waiver certificate valid through October 29, 2026 and lists Jack Laverdiere, Owner, as its authorized official.

NPPES Registry Identity

NPI1902240187
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameGRAND PRAIRIE ASSISTED LIVING
Location Address1307 MEADOWLARK LNMacomb, IL 61455-7508
Mailing Address1307 Meadowlark LnMacomb, IL 61455-7508 · (309) 833-5000 · Fax (309) 833-6410
Phone(309) 833-5000
Fax(309) 833-6410
Organization SubpartNo
Authorized OfficialJack LaverdiereOwner · (309) 837-1258
Enumeration DateApril 18, 2013
✔ NPI 1902240187 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in IL · 5102790
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
1307 MEADOWLARK LN, Macomb, IL 61455
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Other Identifiers 1

Medicaid=========001IL

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2198208

Grand Prairie Suportive Living · Macomb, IL
Active · expires Oct 29, 2026
CLIA Number14D2198208
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 30, 2024
Certificate Expiration DateOctober 29, 2026
Laboratory DirectorJennifer Foster
Laboratory Phone(309) 833-5000
Laboratory LocationGrand Prairie Suportive Living1307 Meadowlark Lane, Macomb, IL 61455
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MACOMB SENIOR LIVING, LLC
Assisted Living Facility
1307 MEADOWLARK LN
MACOMB, IL 61455
McDonough County (309) 833-5000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grand Prairie Assisted Living's NPI number?

The NPI number for Grand Prairie Assisted Living is 1902240187. It was assigned to this organization in the NPPES registry on April 18, 2013.

Where is Grand Prairie Assisted Living located?

Grand Prairie Assisted Living is located at 1307 Meadowlark Ln, Macomb, IL 61455. The listed phone number is (309) 833-5000.

What is Grand Prairie Assisted Living's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Grand Prairie Assisted Living hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2198208) is associated with this NPI, valid through October 29, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Grand Prairie Assisted Living was last updated on April 18, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.