Aunt Martha's Youth Service Center, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

049 Issued in IL

Legal business name

AUNT MARTHA'S YOUTH SERVICE CENTER, INC

Practice address

1515 Lake St
Hanover Park, IL 60133-4896

Phone

(708) 747-7100

NPI assigned

May 30, 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

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1407014046",
    "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": "1515 LAKE ST",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601334896",
            "telephone_number": "708-747-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUNT MARTHA'S YOUTH SERVICE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-30",
        "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": "049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Federally Qualified Health Center (FQHC) in Hanover Park, IL
• Providers in Hanover Park, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.