Organization
AUNT MARTHA'S YOUTH SERVICE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER J NORDLOH (CFO)
(708) 747-7100
Entity
Organization
Contact information
Practice address
1515 LAKE ST, HANOVER PARK, IL 60133-4896
(708) 747-7100
Mailing address
19990 GOVERNORS HWY, OLYMPIA FIELDS, IL 60461-1021
(708) 747-7100
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
049
IL
Other
Enumeration date
05/30/2008
Last updated
07/21/2022
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