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General NPI Number Information
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NPI Number | 1063678530
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Entity Type | Organization
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Legal Business Name | AUNT MARTHA'S YOUTH SERVICE CENTER INC
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1941 SELMARTEN RD
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City | AURORA
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State | IL
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Zip | 60505-1337
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Country | US
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Telephone | 708-754-1044
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Fax |
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Provider Business Mailing Address
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Address Line | 233 W JOE ORR RD
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-1744
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Country | US
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Telephone | 708-754-1044
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JERRY GARVEY
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Credential |
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Telephone | 708-754-1044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 048
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License Number State | IL
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