MEDICARE: AUNT MARTHA'S HEALTH AND WELLNESS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1326979816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUNT MARTHA'S HEALTH AND WELLNESS, INC.

Provider Business Mailing Address
First Line	:	19990 GOVERNORS HWY
Second Line	:
City	:	OLYMPIA FIELDS
State	:	IL
Zip	:	60461-1021
Country	:	US
Telephone Number	:	708-747-7168
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 EXECUTIVE PKWY STE L1
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5291
Country	:	US
Telephone Number	:	877-692-8686
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	LAUREN ANNE NOWOCIN
Credential	:
Telephone Number	:	708-747-7168

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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