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NPI Code Detail

MEDICARE: AUNT MARTHAS YOUTH SERVICE CTR

MEDICARE: AUNT MARTHAS YOUTH SERVICE CTR
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
1101YA0400XAddiction (Substance Use Disorder) Counselor002IL

General Provider Information

NPI Number : 1184826422
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUNT MARTHAS YOUTH SERVICE CTR
Provider Business Mailing Address
First Line : 440 FOREST BLVD
Second Line :
City : PARK FOREST
State : IL
Zip : 60466-2002
Country : US
Telephone Number : 708-679-8000
Fax Number :
Provider Business Practice Location Address
First Line : 233 W JOE ORR RD
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1744
Country : US
Telephone Number : 708-754-1044
Fax Number :
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. GERALD GARVEY
Credential :
Telephone Number : 708-754-1044
Provider Enumeration Date : 05/31/2007
Last Update Date : 07/21/2022

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Directions to “AUNT MARTHAS YOUTH SERVICE CTR ” Practice Location

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