Organization
AUNT MARTHA'S YOUTH SERVICE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER NORDLOH (CFO)
(708) 747-7100
Entity
Organization
Contact information
Practice address
755 PULASKI RD, CALUMET CITY, IL 60409-4030
(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
—
—
Other
Enumeration date
10/06/2009
Last updated
12/02/2010
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