Aunt Martha's Youth Service Center, Inc. | |
17850 Kedzie Ave Suite 3200 Hazel Crest IL 60429-2058 | |
(708) 335-5201 | |
Not Available |
Full Name | Aunt Martha's Youth Service Center, Inc. |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 17850 Kedzie Ave, Hazel Crest, Illinois |
Authorized Official Name and Position | Christopher J Nordloh (CFO) |
Authorized Official Contact | 7087477100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Aunt Martha's Youth Service Center, Inc. 19990 Governors Hwy Olympia Fields IL 60461-1021 Ph: (708) 747-7100 | Aunt Martha's Youth Service Center, Inc. 17850 Kedzie Ave Suite 3200 Hazel Crest IL 60429-2058 Ph: (708) 335-5201 |
NPI Number | 1104054386 |
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Provider Enumeration Date | 06/26/2009 |
Last Update Date | 12/02/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104054386 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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