AUNT MARTHA'S YOUTH SERVICE CENTER INC. NPI 1104054386

NPI Information

  • NPI: 1104054386
  • Provider Name: AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
  • Classification: Clinic/Center - 261QF0400X
  • Specialization: Federally Qualified Health Center (FQHC)
  • Entity Type: Organization
  • Address: 17850 KEDZIE AVE
    SUITE 3200
    HAZEL CREST, IL
    ZIP 60429
  • Phone: (708) 335-5201

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NPI Details

AUNT MARTHA'S YOUTH SERVICE CENTER, INC. is a federally qualified health center (fqhc) clinic center in Hazel Crest, IL. AUNT MARTHA'S YOUTH SERVICE CENTER, INC. NPI is 1104054386. The provider is registered as an organization entity type.

The provider's business location address is:

17850 KEDZIE AVE
SUITE 3200
HAZEL CREST, IL
ZIP 60429-058
Phone: (708) 335-5201

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 enumeration date for this NPI number is 6/26/2009 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 Number License State Primary
1261QF0400XClinic/CenterFederally 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=========064MEDICAIDILLINOIS

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: 3/30/2025

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