AUNT MARTHA'S YOUTH SERVICE CENTER INC; NPI #1174809503

Contact Information

AUNT MARTHA'S YOUTH SERVICE CENTER INC

1301 COPPERFIELD AVENUE
SUITE 201
JOLIET, IL 60432-2056

Phone: 708-747-7100
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Federally Qualified Health Center (FQHC)	261QF0400X	B4[14]	Federally Qualified Health Center

Indicates primary specialty

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NPI Profile & details for AUNT MARTHA'S YOUTH SERVICE CENTER INC

NPI Number 1174809503

LBN Legal business name AUNT MARTHA'S YOUTH SERVICE CENTER INC

Authorized official CHRISTOPHER NORDLOH - (CFO)

Entity Organization

Organization subpart ¹ No

Enumeration date 10/31/2011

Last updated 07/21/2022 - About 4 years ago

Identifiers

License #

077

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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