NPIMap

Organization Active NPI

Aunt Martha'S Youth Service Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Chicago, IL
National Provider Identifier
1295835023
Registry record updated Mar 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
AUNT MARTHA'S YOUTH SERVICE CENTER
Practice address
8640 S South Chicago Ave
Chicago, IL 60617-2314
Phone
(773) 731-9100
Fax
(708) 747-7907
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2017

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

Authorized official

Name
Mary Martin
Title
Chief Financial Officer
Phone
(708) 825-5976

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

8640 S South Chicago Ave
Chicago, IL 60617-2314

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
237248446004MedicaidIL
2371881580080MedicaidIL

Other names 1

  • Aunt Martha's SEADAC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Aunt Marthas74 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

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488931200000",
    "number": "1295835023",
    "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",
            "fax_number": "708-747-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8640 S SOUTH CHICAGO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606172314",
            "telephone_number": "773-731-9100",
            "fax_number": "708-747-7907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUNT MARTHA'S YOUTH SERVICE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2017-03-08",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "708-825-5976"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "237248446004",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2371881580080",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aunt Martha's SEADAC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.