Aunt Marthas Youth Service
Clinic/Center, Federally Qualified Health Center (FQHC) in Olympia Fields, IL. Organization (NPI-2).
NPI number1013045707
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1013045707
- Entity type
- Organization (NPI-2)
- Legal business name
- Aunt Marthas Youth Service
- Organization subpart
- No
- Enumeration date
- Mar 2, 2007
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | 041 | IL | Yes |
Practice location
19990 Governors HwyOlympia Fields, IL 60461-1021
Phone 708-747-7100
Mailing address
19990 Governors HwyOlympia Fields, IL 60461-1021
Phone 708-747-7100
Authorized official
Mary M Martin
Controller
7087477100
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