Organization
AUNT MARTHA'S YOUTH SERVICE CENTER
Active
Other names
Aunt Martha's SEADAC
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MARTIN (CHIEF FINANCIAL OFFICER)
(708) 825-5976
Entity
Organization
Contact information
Practice address
8640 S SOUTH CHICAGO AVE, CHICAGO, IL 60617-2314
(773) 731-9100
(708) 747-7907
Mailing address
19990 GOVERNORS HWY, OLYMPIA FIELDS, IL 60461-1021
(708) 747-7100
(708) 747-0710
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2371881580080
—
IL
05
—
237248446004
—
IL
Enumeration date
09/22/2006
Last updated
03/08/2017
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