Organization
AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY PENNINGTON (EXEC. VP OF HEALTH)
(773) 802-7645
Entity
Organization
Contact information
Practice address
45 W 111TH ST, CHICAGO, IL 60628-4200
(877) 692-8686
(708) 747-8024
Mailing address
19990 GOVERNORS HWY, OLYMPIA FIELDS, IL 60461-1021
(708) 747-7100
(708) 747-0710
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
08/17/2012
Last updated
11/02/2016
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