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Organization

AUNT MARTHA'S YOUTH SERVICE CENTER INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTOPHER J NORDLOH (CFO)
(708) 747-7100
Entity
Organization

Contact information

Practice address
1301 COPPERFIELD AVENUE, SUITE 201, JOLIET, IL 60432-2056
(708) 747-7100
Mailing address
19990 GOVERNORS HIGHWAY, OLYMPIA FIELDS, IL 60461-1021
(708) 747-7100

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
077
IL

Other

Enumeration date
10/31/2011
Last updated
07/21/2022
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