AUNT MARTHAS YOUTH SERVICE CENTER NPI 1225080922

NPI Information

NPI: 1225080922
Provider Name: AUNT MARTHAS YOUTH SERVICE CENTER
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 14D2046318

Address:
19990 GOVERNORS HWY
OLYMPIA FIELDS, IL
ZIP 60461
Phone: (708) 747-7100
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AUNT MARTHAS YOUTH SERVICE CENTER is a federally qualified health center (fqhc) clinic center in Olympia Fields, IL. AUNT MARTHAS YOUTH SERVICE CENTER NPI is 1225080922. The provider is registered as an organization entity type.

The provider's business location address is:

19990 GOVERNORS HWY
OLYMPIA FIELDS, IL
ZIP 60461-021
Phone: (708) 747-7100

The provider's authorized official is Christopher J Nordloh .
The authorized official title is Cfo and has the following contact phone number (708) 747-7100.

The CLIA number assigned to this NPI record is 14D2046318 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/17/2006 and was last updated on 12/2/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	251B00000X	Case Management		ILLINOIS	No
2	251C00000X	Day Training, Developmentally Disabled Services		ILLINOIS	No
3	251K00000X	Public Health or Welfare		ILLINOIS	No
4	251J00000X	Nursing Care		ILLINOIS	No
5	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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