Aunt Martha's Health and Wellness, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

044 Issued in IL

Legal business name

AUNT MARTHA'S HEALTH AND WELLNESS, INC.

Doing business as

Aunt Martha's Hazel Crest Community Health Center

Practice address

17850 Kedzie Ave Ste 1150
Hazel Crest, IL 60429-2095

Phone

(877) 692-8686

Fax

(708) 747-8038

NPI assigned

Aug 24, 2007

Last updated

Aug 5, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lauren Anne Nowocin

Title

Credentialing Coordinator

Phone

(708) 747-7168

Specialties & licenses 1

Addresses

Other names 1

• Aunt Martha's Hazel Crest Community Health Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174716823. Details of each certification follow.

• CCN 141102 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 141102

Legal name

AUNT MARTHA'S HAZEL CREST COMMUNITY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 18, 2009

Last certification

Aug 18, 2009

Ownership / control type

For profit – corporation

Facility address

17850 S Kedzie Avenue
Hazel Crest, IL 60429

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ethan Hoeldtke, PA-C

  • Physician Assistant
  • Hazel Crest, IL
  • NPI 1194560227
  NPD (past)
• Olivia Rose Safranek, PA-C

  • Physician Assistant
  • Hazel Crest, IL
  • NPI 1164353611
  NPD (past)

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

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785888000000",
    "number": "1174716823",
    "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": "708-747-7168",
            "fax_number": "708-747-8038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17850 KEDZIE AVE STE 1150",
            "city": "HAZEL CREST",
            "state": "IL",
            "postal_code": "604292095",
            "telephone_number": "877-692-8686",
            "fax_number": "708-747-8038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUNT MARTHA'S HEALTH AND WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A",
        "authorized_official_last_name": "NOWOCIN",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "708-747-7168"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": "044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aunt Martha's Hazel Crest Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Federally Qualified Health Center (FQHC) in Hazel Crest, IL
• Providers in Hazel Crest, IL by specialty
• Federally Qualified Health Center (FQHC) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.