Organization
AUNT MARTHA'S YOUTH SERVICE CENTER
Active
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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