Aunt Marthas Youth Service Center Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

046 Issued in IL

Legal business name

AUNT MARTHAS YOUTH SERVICE CENTER INC

Doing business as

Aunt Marthas Calumet City Community Health Center

Practice address

602 Torrence Ave
Calumet City, IL 60409-3813

Phone

(708) 747-7100

Fax

(708) 747-0710

NPI assigned

Mar 17, 2008

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 Calumet City 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 1336310523. Details of each certification follow.

• CCN 141082 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 141082

Legal name

AUNT MARTHA'S CALUMET CITY COMMUNITY HEALTH CTR

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

602 Torrence Avenue
Calumet City, IL 60409

Locations

Practitioners 1

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.

• Jennifer Byrd, MD

  • Family Medicine Physician
  • Chicago Heights, IL
  • NPI 1033232749
  NPD (past)

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

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1336310523",
    "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": "602 TORRENCE AVE",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604093813",
            "telephone_number": "708-747-7100",
            "fax_number": "708-747-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUNT MARTHAS YOUTH SERVICE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "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": "046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aunt Marthas Calumet City Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cicely N Argue, LSW
• Cynthia R Arnold
• Janet Ashley, SOCIALWORKER
• Atlas Healthcare Management, Inc
• Aunt Martha's Youth Service Center
• Paula Ball
• Bansa Medical Associates Inc
• Davida Barner, LCSW
• Beacon Pace Illinois LLC (BoldAge PACE Illinois)
• Demetria Bender

• Federally Qualified Health Center (FQHC) in Calumet City, IL
• Providers in Calumet City, 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.