Aunt Marthas Youth Service Center, INC
Clinic/Center, Federally Qualified Health Center (FQHC) in Olympia Fields, IL. Organization (NPI-2).
NPI number1609124676
StatusActive
Last updated in NPPESFeb 27, 2013
Details
- NPI
- 1609124676
- Entity type
- Organization (NPI-2)
- Legal business name
- Aunt Marthas Youth Service Center, INC
- Organization subpart
- No
- Enumeration date
- Aug 24, 2012
- Last updated
- Feb 27, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | – | – | Yes |
Practice location
19990 Governors HwyOlympia Fields, IL 60461-1021
Phone 708-747-7100
Mailing address
1301 Copperfield AveSuite 202
Joliet, IL 60432-2054
Authorized official
Christopher J Nordloh
Cfo
7087477100
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