NPIMap

Organization Active NPI

Aunt Martha's Youth Service Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hazel Crest, IL
National Provider Identifier
1104054386
Registry record updated Dec 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
Practice address
17850 Kedzie Ave
Suite 3200
Hazel Crest, IL 60429-2058
Phone
(708) 335-5201
NPI assigned
Jun 26, 2009
Last updated
Dec 2, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Christopher J Nordloh
Title
Cfo
Phone
(708) 747-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

17850 Kedzie Ave
Suite 3200
Hazel Crest, IL 60429-2058

Mailing address

19990 Governors Hwy
Olympia Fields, IL 60461-1021
Phone (708) 747-7100

National Provider Directory

National Provider Directory
Tax ID family
Aunt Marthas Youth Service74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

17850 Kedzie Ave
Ste 3200
Hazel Crest, IL 60429
Phone (708) 335-5201

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291248000000",
    "number": "1104054386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19990 GOVERNORS HWY",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611021",
            "telephone_number": "708-747-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17850 KEDZIE AVE",
            "address_2": "SUITE 3200",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292058",
            "telephone_number": "708-335-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUNT MARTHA'S YOUTH SERVICE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-26",
        "last_updated": "2010-12-02",
        "status": "A",
        "authorized_official_last_name": "NORDLOH",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "708-747-7100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazel Crest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.