Aunt Marthas Youth Service Center Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

029 Issued in IL

Legal business name

AUNT MARTHAS YOUTH SERVICE CENTER INC

Doing business as

Aunt Marthas Harvey Community Health Center

Practice address

159 E 154TH St
Harvey, IL 60426-3325

Phone

(708) 747-7100

NPI assigned

Feb 6, 2007

Last updated

Jul 21, 2022By 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

Mr. Christopher J Nordloh

Title

Cfo

Phone

(708) 747-7100

Specialties & licenses 1

Addresses

Other names 1

• Aunt Marthas Harvey 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 1184764730. Details of each certification follow.

• CCN 141084 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 141084

Legal name

AUNT MARTHA'S HARVEY COMMUNITY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 18, 2008

Last certification

Sep 18, 2008

Ownership / control type

For profit – corporation

Facility address

159 E 154TH Street
Harvey, IL 60426

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Aunt Martha's Health and Wellness, Inc.

  dba Aunt Martha's Women's Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago Heights, IL
  • NPI 1831239490

  Member Of

  NPD member

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1184764730",
    "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": "159 E 154TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263325",
            "telephone_number": "708-747-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUNT MARTHAS YOUTH SERVICE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2022-07-21",
        "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": "IL",
            "license": "029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aunt Marthas Harvey Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eyad Atieh, MD
• Aunt Martha's Health and Wellness, Inc. (Aunt Martha's South Suburban HOC)
• Aunt Martha's Youth Service Center
• Aunt Martha's Youth Service Center, Inc.
• Aunt Marthas Youth Service Center Inc
• Mfombu Ayukesong, CSA
• John William Baldwin, DO
• Kamilah Banks Word
• Tiara Banks, LCSW
• Laverne Monise Barnes, DO, MPH

• Federally Qualified Health Center (FQHC) in Harvey, IL
• Providers in Harvey, 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 Jul 21, 2022; 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.