NPIMap

Organization Active NPI

Aunt Martha's Youth Service Center

Doing business as Aunt Martha's Blue Island Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Blue Island, IL
National Provider Identifier
1174070676
Registry record updated Jan 13, 2017
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
Doing business as
Aunt Martha's Blue Island Community Health Center
Practice address
12139 S. Western Ave
Blue Island, IL 60406
Phone
(877) 692-8686
NPI assigned
Sep 1, 2016
Last updated
Jan 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2017

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

Authorized official

Name
Audrey Pennington
Title
Executive VP of Health
Phone
(773) 802-7645

Specialties & licenses 1

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

Addresses

Primary practice location

12139 S. Western Ave
Blue Island, IL 60406

Mailing address

19900 Governors Dr
Olympia Fields, IL 60461-1057

Other names 1

  • Aunt Martha's Blue Island Community Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Aunt Marthas75 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Locations

12139 Western Ave
Blue Island, IL 60406

NPI Registry JSON

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1174070676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19900 GOVERNORS DR",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12139 S. WESTERN AVE",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "60406",
            "telephone_number": "877-692-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUNT MARTHA'S YOUTH SERVICE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "EXECUTIVE VP OF HEALTH",
        "authorized_official_telephone_number": "773-802-7645"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aunt Martha's Blue Island Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blue Island, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2017; 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.