Organization
AUNT MARTHAS 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
19990 GOVERNORS HWY, OLYMPIA FIELDS, IL 60461-1021
(708) 747-7100
Mailing address
1301 COPPERFIELD AVE, SUITE 202, JOLIET, IL 60432-2054
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
08/24/2012
Last updated
02/27/2013
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